Provider Demographics
NPI:1376886762
Name:KERRIAN, THOMAS J (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:KERRIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9955 CARMEL MOUNTAIN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2815
Mailing Address - Country:US
Mailing Address - Phone:858-484-3100
Mailing Address - Fax:858-484-8510
Practice Address - Street 1:9955 CARMEL MOUNTAIN RD STE 4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2815
Practice Address - Country:US
Practice Address - Phone:858-484-3100
Practice Address - Fax:858-484-8510
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist