Healthcare Provider Details

I. General information

NPI: 1164671368
Provider Name (Legal Business Name): JOHN MITCHELL KREHER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 E NEW HAVEN AV
MELBOURNE FL
32901
US

IV. Provider business mailing address

523 E NEW HAVEN AV
MELBOURNE FL
32901
US

V. Phone/Fax

Practice location:
  • Phone: 321-723-0822
  • Fax: 321-723-6879
Mailing address:
  • Phone: 321-723-0822
  • Fax: 321-723-6879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: