Provider Demographics
NPI:1518033059
Name:KERR, MATTHEW IAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:IAN
Last Name:KERR
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 1:6040 S RAINBOW BLVD #B 2
Mailing Address - Street 2:ATTN NORIE CORPUZ
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118
Mailing Address - Country:US
Mailing Address - Phone:702-880-4266
Mailing Address - Fax:702-792-4266
Practice Address - Street 1:4300 E SUNSET RD #B 2
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014
Practice Address - Country:US
Practice Address - Phone:702-968-0707
Practice Address - Fax:702-968-0708
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4841T122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist