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General NPI Number Information
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NPI Number | 1194078063
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Entity Type | Individual
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Provider Name | KEVIN EUGENE KEMARLY D.M.D
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Gender | Male
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 7300 N PERIMETER RD
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City | MALMSTROM AFB
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State | MT
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Zip | 59402
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Country | US
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Telephone | 67-313-3184
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Fax |
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Provider Business Mailing Address
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Address Line | 3278 MITCHELL BLVD BLDG 900
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City | MOODY AFB
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State | GA
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Zip | 31699-1500
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Country | US
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Telephone | 229-257-4304
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.029220
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License Number State | IL
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