Provider Demographics
NPI:1376634600
Name:KERN, KYLE DOUGLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DOUGLAS
Last Name:KERN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:KYLE
Other - Middle Name:DOUGLAS
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, PC
Mailing Address - Street 1:221 VILLA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1828
Mailing Address - Country:US
Mailing Address - Phone:503-538-6449
Mailing Address - Fax:503-554-9936
Practice Address - Street 1:221 VILLA RD
Practice Address - Street 2:SUITE A
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1828
Practice Address - Country:US
Practice Address - Phone:503-538-6449
Practice Address - Fax:503-554-9936
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD67861223G0001X
NC62961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice