Provider Demographics
NPI:1295148807
Name:KERNS, AMANDA (DDS, MS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KERNS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:KILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1904
Mailing Address - Fax:704-864-7608
Practice Address - Street 1:890 SUMMIT CROSSING PL
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2192
Practice Address - Country:US
Practice Address - Phone:704-874-0377
Practice Address - Fax:704-853-5455
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014152171223P0221X
NC112711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry