Provider Demographics
NPI:1639194491
Name:KERO, TAKOMA M (DDS)
Entity Type:Individual
Prefix:
First Name:TAKOMA
Middle Name:M
Last Name:KERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2406
Mailing Address - Country:US
Mailing Address - Phone:650-952-7315
Mailing Address - Fax:650-952-7317
Practice Address - Street 1:1178 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2406
Practice Address - Country:US
Practice Address - Phone:650-952-7315
Practice Address - Fax:650-952-7317
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist