Provider Demographics
NPI:1568583342
Name:RICHARD M KERNAGIS DMD PA
Entity Type:Organization
Organization Name:RICHARD M KERNAGIS DMD PA
Other - Org Name:KERNAGIS DENTAL EXCELLENCE DENTAL EXCELLENCE AT FISHHAWK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KERNAGIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-571-5555
Mailing Address - Street 1:5486 LITHIA PINE CREST RD
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547
Mailing Address - Country:US
Mailing Address - Phone:813-571-5555
Mailing Address - Fax:813-571-5559
Practice Address - Street 1:5486 LITHIA PINE CREST RD
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547
Practice Address - Country:US
Practice Address - Phone:813-571-5555
Practice Address - Fax:813-571-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15191122300000X
FLDN15256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty