Provider Demographics
NPI:1396008132
Name:KERR, DEREK REID (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:REID
Last Name:KERR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213-1286
Mailing Address - Country:US
Mailing Address - Phone:641-342-6541
Mailing Address - Fax:
Practice Address - Street 1:148 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-1286
Practice Address - Country:US
Practice Address - Phone:641-342-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09259122300000X
MO2012018222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist