Provider Demographics
NPI:1801168521
Name:KERN, JACK (DDS)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:KERN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11 CRICKETT LN
Mailing Address - Street 2:
Mailing Address - City:KINGS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 CRICKETT LN
Practice Address - Street 2:11 CRICKET LANE
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024-1004
Practice Address - Country:US
Practice Address - Phone:516-466-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21510122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist