Provider Demographics
NPI:1730824129
Name:KEROLUS, KRISTINA (DDS)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:KEROLUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FERNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3333
Mailing Address - Country:US
Mailing Address - Phone:718-757-1196
Mailing Address - Fax:
Practice Address - Street 1:270 BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-7027
Practice Address - Country:US
Practice Address - Phone:732-923-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program