Provider Demographics
NPI:1174531818
Name:KERSTEN, DANIEL DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DOUGLAS
Last Name:KERSTEN
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 1:1720 JET STREAM DR STE 110
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3938
Mailing Address - Country:US
Mailing Address - Phone:719-488-2188
Mailing Address - Fax:
Practice Address - Street 1:1720 JET STREAM DR STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3938
Practice Address - Country:US
Practice Address - Phone:719-488-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND117921223E0200X, 1223G0001X
AK14601223E0200X
CODEN.002039731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice