Provider Demographics
NPI:1609014521
Name:ROBERT C KERSCHEN, DMD
Entity Type:Organization
Organization Name:ROBERT C KERSCHEN, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KERSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:505-898-7440
Mailing Address - Street 1:2600 AMERICAN RD SE STE 230
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1858
Mailing Address - Country:US
Mailing Address - Phone:505-898-7440
Mailing Address - Fax:505-898-6169
Practice Address - Street 1:2600 AMERICAN RD SE STE 230
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1858
Practice Address - Country:US
Practice Address - Phone:505-898-7440
Practice Address - Fax:505-898-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM25451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty