Provider Demographics
NPI:1437761319
Name:KERN, ERIN LEE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LEE
Last Name:KERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 S GENERAL BRUCE DR STE D103
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-5138
Mailing Address - Country:US
Mailing Address - Phone:254-771-1115
Mailing Address - Fax:
Practice Address - Street 1:3550 S GENERAL BRUCE DR STE D103
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-5138
Practice Address - Country:US
Practice Address - Phone:254-771-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice