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General NPI Number Information
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NPI Number | 1043382765
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Entity Type | Individual
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Provider Name | GREGORY JOHN KEMMITT DDS
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11601 MINNETONKA MILLS RD
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City | MINNETONKA
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State | MN
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Zip | 55305-5161
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Country | US
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Telephone | 952-938-8858
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Fax |
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Provider Business Mailing Address
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Address Line | 3947 WILD MEADOWS DR
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City | MEDINA
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State | MN
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Zip | 55340-9806
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Country | US
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Telephone | 763-478-2954
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9707
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License Number State | MN
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