Healthcare Provider Details

I. General information

NPI: 1295465672
Provider Name (Legal Business Name): TYLER SCOTT KEMERER DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2575
US

IV. Provider business mailing address

3315 N GLEANER RD
FREELAND MI
48623-8829
US

V. Phone/Fax

Practice location:
  • Phone: 910-451-1658
  • Fax:
Mailing address:
  • Phone: 989-860-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901601332
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: