Healthcare Provider Details

I. General information

NPI: 1780972711
Provider Name (Legal Business Name): MELANIE L KEMMERER, DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SUWANNEE AVE SW
BRANFORD FL
32008-2749
US

IV. Provider business mailing address

110 SUWANNEE AVE SW P.O. BOX 930
BRANFORD FL
32008-2749
US

V. Phone/Fax

Practice location:
  • Phone: 386-935-0988
  • Fax: 386-935-0989
Mailing address:
  • Phone: 386-935-0988
  • Fax: 386-935-0989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDN17680
License Number StateFL

VIII. Authorized Official

Name: MELANIE LYNN KEMMERER
Title or Position: MANAGER
Credential: DMD
Phone: 352-514-9159