Provider Demographics
NPI:1801050612
Name:WOOTEN-KERR, JANEICE AISHA (DDS)
Entity type:Individual
Prefix:DR
First Name:JANEICE
Middle Name:AISHA
Last Name:WOOTEN-KERR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 SHOEMAKER DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6501
Mailing Address - Country:US
Mailing Address - Phone:313-204-4775
Mailing Address - Fax:
Practice Address - Street 1:4420 DIXIE HWY STE 110
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2986
Practice Address - Country:US
Practice Address - Phone:502-447-3323
Practice Address - Fax:913-752-9116
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9887122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist