Provider Demographics
NPI:1619649548
Name:KEGERREIS DENTAL, INC.
Entity Type:Organization
Organization Name:KEGERREIS DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCHIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-866-5123
Mailing Address - Street 1:219 W HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-2360
Mailing Address - Country:US
Mailing Address - Phone:717-866-5123
Mailing Address - Fax:717-866-2967
Practice Address - Street 1:219 W HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:MYERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17067-2360
Practice Address - Country:US
Practice Address - Phone:717-866-5123
Practice Address - Fax:717-866-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty