Provider Demographics
NPI:1245633650
Name:KERRY A. DOVE, DMD MS, PLLC
Entity type:Organization
Organization Name:KERRY A. DOVE, DMD MS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:ANZENBERGER
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:704-795-2300
Mailing Address - Street 1:5641 POPLAR TENT RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7533
Mailing Address - Country:US
Mailing Address - Phone:704-795-2300
Mailing Address - Fax:704-795-2301
Practice Address - Street 1:5641 POPLAR TENT RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7533
Practice Address - Country:US
Practice Address - Phone:704-795-2300
Practice Address - Fax:704-795-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1942430939Medicaid