Provider Demographics
NPI:1568039204
Name:KERR, MARYANNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARYANNA
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W BROADWAY APT 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1951
Mailing Address - Country:US
Mailing Address - Phone:774-283-0569
Mailing Address - Fax:
Practice Address - Street 1:3 MARKET XING
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7841
Practice Address - Country:US
Practice Address - Phone:508-747-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18591161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice