Provider Demographics
NPI:1487864203
Name:KERN, DAVID MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:KERN
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 1:41307 12TH ST W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1445
Mailing Address - Country:US
Mailing Address - Phone:661-267-2021
Mailing Address - Fax:661-267-2664
Practice Address - Street 1:41307 12TH ST W
Practice Address - Street 2:SUITE 100
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1445
Practice Address - Country:US
Practice Address - Phone:661-267-2021
Practice Address - Fax:661-267-2664
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95-42352821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice