Provider Demographics
NPI:1457407181
Name:KERINS, CAROLYN (DDS,PHD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:KERINS
Suffix:
Gender:F
Credentials:DDS,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 GASTON AVE
Mailing Address - Street 2:ROOM 203A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2013
Mailing Address - Country:US
Mailing Address - Phone:214-828-8133
Mailing Address - Fax:214-874-4508
Practice Address - Street 1:3302 GASTON AVE
Practice Address - Street 2:ROOM 203A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2013
Practice Address - Country:US
Practice Address - Phone:214-828-8133
Practice Address - Fax:214-874-4508
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1457407181Medicaid
TX162250802Medicaid
TX162250805Medicaid
TX1295777324Medicaid
TX20883OtherCDC CHIP
TX126726206Medicaid
TX162250804Medicaid
TX1134162746Medicaid