Provider Demographics
NPI:1790277416
Name:DJERF, KELLY RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:RAE
Last Name:DJERF
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 1:7373 FRANCE AVE S STE 500
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4551
Mailing Address - Country:US
Mailing Address - Phone:952-831-2800
Mailing Address - Fax:
Practice Address - Street 1:7373 FRANCE AVE S STE 500
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4551
Practice Address - Country:US
Practice Address - Phone:952-831-2800
Practice Address - Fax:952-831-5805
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14010122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist