Provider Demographics
NPI:1205057569
Name:KIRSCH, KERI MOORMAN (DMD)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:MOORMAN
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BILTMORE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3402
Mailing Address - Country:US
Mailing Address - Phone:502-895-9929
Mailing Address - Fax:
Practice Address - Street 1:13320 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3936
Practice Address - Country:US
Practice Address - Phone:502-254-8494
Practice Address - Fax:502-254-3755
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist