Provider Demographics
NPI:1801934054
Name:KERNS, LISA L (DDS MS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:KERNS
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LOOMIS
Other - Last Name:KERNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5180 WEST WACO DRIVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710
Mailing Address - Country:US
Mailing Address - Phone:254-399-9800
Mailing Address - Fax:254-399-9700
Practice Address - Street 1:5180 WEST WACO DRIVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710
Practice Address - Country:US
Practice Address - Phone:254-399-9800
Practice Address - Fax:254-399-9700
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics