Provider Demographics
NPI:1407014418
Name:KERRY, KAREN D (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:D
Last Name:KERRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 PLYMOUTH ROAD
Mailing Address - Street 2:104
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2555
Mailing Address - Country:US
Mailing Address - Phone:734-995-0515
Mailing Address - Fax:734-995-1299
Practice Address - Street 1:3250 PLYMOUTH ROAD
Practice Address - Street 2:104
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2555
Practice Address - Country:US
Practice Address - Phone:734-995-0515
Practice Address - Fax:734-995-1299
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI140991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice