Healthcare Provider Details

I. General information

NPI: 1376114561
Provider Name (Legal Business Name): KRISTEN M. KEMMER, DDS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 08/06/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 ALEXANDER ST SE
GRAND RAPIDS MI
49506-3384
US

IV. Provider business mailing address

1501 ALEXANDER ST SE
GRAND RAPIDS MI
49506-3384
US

V. Phone/Fax

Practice location:
  • Phone: 989-980-6539
  • Fax:
Mailing address:
  • Phone: 989-980-6539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KRISTEN M KEMMER
Title or Position: PRESIDENT
Credential: DDS
Phone: 989-980-6539