Provider Demographics
NPI:1538273891
Name:KITTERMAN, KERRY KERR (DDS)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:KERR
Last Name:KITTERMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:KERR
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2930 S PITTSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114
Mailing Address - Country:US
Mailing Address - Phone:918-742-9810
Mailing Address - Fax:918-742-8301
Practice Address - Street 1:2930 S PITTSBURG AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114
Practice Address - Country:US
Practice Address - Phone:918-742-9810
Practice Address - Fax:918-742-8301
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist