MEDICARE: DR. WAYNE H. KEHM II DDS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	FL5865	FL

General Provider Information

NPI Number	:	1306030069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE H. KEHM II DDS, PA

Provider Business Mailing Address
First Line	:	4850 1ST AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-8108
Country	:	US
Telephone Number	:	727-321-4850
Fax Number	:	727-323-1679

Provider Business Practice Location Address
First Line	:	4850 1ST AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-8108
Country	:	US
Telephone Number	:	727-321-4850
Fax Number	:	727-323-1679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	09/05/2007

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