Provider Demographics
NPI:1548354558
Name:KERSTING, THOMAS EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:KERSTING
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 1:100 E KIMBERLY RD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-5924
Mailing Address - Country:US
Mailing Address - Phone:563-386-3065
Mailing Address - Fax:563-388-5981
Practice Address - Street 1:100 E KIMBERLY RD
Practice Address - Street 2:SUITE 501
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5924
Practice Address - Country:US
Practice Address - Phone:563-386-3065
Practice Address - Fax:563-388-5981
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA067991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice