Provider Demographics
NPI:1669546669
Name:KEARNS, JOHN R (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:KEARNS
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 1:5328 GLEN OAKS WAY
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6668
Mailing Address - Country:US
Mailing Address - Phone:515-287-2493
Mailing Address - Fax:
Practice Address - Street 1:4551 FLEUR DR
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50321-2331
Practice Address - Country:US
Practice Address - Phone:515-287-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA66781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1190660Medicaid
IA19006OtherBCBS PROVIDER NUMBER
IA6678OtherDELTA DENTAL PROVIDER NUM