Provider Demographics
NPI:1811526015
Name:KILGORE, KERI ANN (PHDHP)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:ANN
Last Name:KILGORE
Suffix:
Gender:F
Credentials:PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614-G ESKHELMAN MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584
Mailing Address - Country:US
Mailing Address - Phone:717-644-0322
Mailing Address - Fax:
Practice Address - Street 1:744 E LINCOLN HWY STE 110
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3590
Practice Address - Country:US
Practice Address - Phone:610-380-4660
Practice Address - Fax:610-380-4664
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH012387L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist