Organization
KERNAN ORAL MAXILLOFACIAL & IMPLANT SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN THOMAS KERNAN DDS (PRESIDENT ORAL MAXILLOFACIAL SURGEO)
(937) 885-7204
Entity
Organization
Contact information
Practice address
9995 DAYTON LEBANON PIKE, CENTERVILLE, OH 45458
(937) 885-7204
(937) 885-7206
Mailing address
9995 DAYTON LEBANON PIKE, CENTERVILLE, OH 45458
(937) 885-7204
(937) 885-7206
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
18518
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0666060
—
OH
01
—
KE4118162
MEDICARE INDIVIDUAL
OH
01
—
KE9357911
MEDICARE GROUP
OH
Enumeration date
03/12/2008
Last updated
03/12/2008
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