Provider Demographics
NPI:1427021328
Name:KERR, JEFFERY HAYES (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:HAYES
Last Name:KERR
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 1:5021 N BROADWAY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-9433
Mailing Address - Country:US
Mailing Address - Phone:918-647-9477
Mailing Address - Fax:918-647-4595
Practice Address - Street 1:5021 N BROADWAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-9433
Practice Address - Country:US
Practice Address - Phone:918-647-9477
Practice Address - Fax:918-647-4595
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2830-941223G0001X
OK58341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice