Provider Demographics
NPI:1861587503
Name:JEFFRY SCOTT KERBS DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JEFFRY SCOTT KERBS DDS A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KERBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-580-2971
Mailing Address - Street 1:127 E 3RD AVE # 100
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4201
Mailing Address - Country:US
Mailing Address - Phone:760-746-3663
Mailing Address - Fax:760-746-4069
Practice Address - Street 1:127 E 3RD AVE # 100
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4201
Practice Address - Country:US
Practice Address - Phone:760-746-3663
Practice Address - Fax:760-746-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherMET-LIFE