Provider Demographics
NPI:1417080151
Name:KERTSCHER, ROBERT CHRISTIAN (DDS PC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHRISTIAN
Last Name:KERTSCHER
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9942 MAIN ST
Mailing Address - Street 2:FAIRFAX SQ PROF CENTER
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:703-273-1124
Mailing Address - Fax:703-273-7187
Practice Address - Street 1:9942 MAIN ST
Practice Address - Street 2:FAIRFAX SQ PROF CENTER
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-273-1124
Practice Address - Fax:703-273-7187
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA31261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice