Provider Demographics
NPI:1184877169
Name:DISCEPOLO, KERI (DDS)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:
Last Name:DISCEPOLO
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 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-1000
Mailing Address - Country:US
Mailing Address - Phone:860-679-2207
Mailing Address - Fax:860-679-1899
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:DEPT. OF PEDIATRIC DENTISTRY
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-1710
Practice Address - Country:US
Practice Address - Phone:860-679-7155
Practice Address - Fax:860-679-1899
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0099471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry