Provider Demographics
NPI:1801955059
Name:KERR, CLIFFORD DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:DEAN
Last Name:KERR
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 1:840 S FAIRMONT AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240
Mailing Address - Country:US
Mailing Address - Phone:209-369-0345
Mailing Address - Fax:209-369-0363
Practice Address - Street 1:840 S FAIRMONT AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240
Practice Address - Country:US
Practice Address - Phone:209-369-0345
Practice Address - Fax:209-369-0363
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice