Provider Demographics
NPI:1508297110
Name:KERNAGIS DENTAL EXCELLENCE PA
Entity Type:Organization
Organization Name:KERNAGIS DENTAL EXCELLENCE PA
Other - Org Name:KERNAGIS DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KERNAGIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-932-3940
Mailing Address - Street 1:2001 W BUSCH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7517
Mailing Address - Country:US
Mailing Address - Phone:813-932-3940
Mailing Address - Fax:
Practice Address - Street 1:2001 W BUSCH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7517
Practice Address - Country:US
Practice Address - Phone:813-932-3940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty