Provider Demographics
NPI:1790852689
Name:KERSTEIN, ROBERT BARRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BARRY
Last Name:KERSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 BEACON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-247-1700
Mailing Address - Fax:617-247-1611
Practice Address - Street 1:665 BEACON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-247-1700
Practice Address - Fax:617-247-1611
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15678122300000X, 1223G0001X
MA156501223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0700XDental ProvidersDentistProsthodontics