Provider Demographics
NPI:1750692257
Name:LORETONI, KERSDEN
Entity type:Individual
Prefix:
First Name:KERSDEN
Middle Name:
Last Name:LORETONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 AMHERST ST
Mailing Address - Street 2:APT 19
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:STRONGHURST
Practice Address - State:IL
Practice Address - Zip Code:61480-5033
Practice Address - Country:US
Practice Address - Phone:309-924-1381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028234122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist