Provider Demographics
NPI:1689719288
Name:JOHN D KERNAN DMD PA
Entity Type:Organization
Organization Name:JOHN D KERNAN DMD PA
Other - Org Name:WILLIAM T DEFEO DDS PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CONTROLLER SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:UBER
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-869-8660
Mailing Address - Street 1:658 W CUTHBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-3642
Mailing Address - Country:US
Mailing Address - Phone:856-869-8660
Mailing Address - Fax:856-869-8686
Practice Address - Street 1:658 W CUTHBERT BLVD
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:NJ
Practice Address - Zip Code:08108-3642
Practice Address - Country:US
Practice Address - Phone:856-869-8660
Practice Address - Fax:856-869-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011002001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty