Healthcare Provider Details

I. General information

NPI: 1679940118
Provider Name (Legal Business Name): KUENNEMEIER AND KELLEY DENTAL PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3241 MOUNT CARMEL RD
CINCINNATI OH
45244-4315
US

IV. Provider business mailing address

3241 MOUNT CARMEL RD
CINCINNATI OH
45244-4315
US

V. Phone/Fax

Practice location:
  • Phone: 513-753-0044
  • Fax: 513-753-0093
Mailing address:
  • Phone: 513-753-0044
  • Fax: 513-753-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16903
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23243
License Number StateOH

VIII. Authorized Official

Name: DR. STEPHEN PAUL KUENNEMEIER
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 513-753-0044