Individual provider Active NPI

Robert Charles Kerschen, DMD

  • General Practice Dentistry
  • Albuquerque, NM
National Provider Identifier
1821014432
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DD 2545 Issued in NM
Practice address
4273 Montgomery Blvd NE Ste 120
Albuquerque, NM 87109-6746
Phone
(505) 883-3229
NPI assigned
Jul 15, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DD 2545 NM Primary

Addresses

Primary practice location

4273 Montgomery Blvd NE Ste 120
Albuquerque, NM 87109-6746

Mailing address

9004 Opportunity Dr NE
Albuquerque, NM 87109-5151
Phone (505) 821-1935

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160301000802 NM Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7810292810

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DD 2545NMMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821014432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9004 OPPORTUNITY DR NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871095151",
            "telephone_number": "505-821-1935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4273 MONTGOMERY BLVD NE STE 120",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871096746",
            "telephone_number": "505-883-3229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERSCHEN",
        "first_name": "ROBERT",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD 2545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.