Provider Demographics
NPI:1851470736
Name:KERZNER, SHOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHOEL
Middle Name:
Last Name:KERZNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 OLD ORCHARD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:847-676-2270
Mailing Address - Fax:847-676-2304
Practice Address - Street 1:64 OLD ORCHARD
Practice Address - Street 2:SUITE 410
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-676-2270
Practice Address - Fax:847-676-2304
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics