Provider Demographics
NPI:1083671051
Name:HEMKER, MICHAEL LEO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEO
Last Name:HEMKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 557 STERNBERG AVENUE
Mailing Address - Street 2:FT EUSTIS DENTAC
Mailing Address - City:FORT EUSTIS
Mailing Address - State:VA
Mailing Address - Zip Code:23604-5311
Mailing Address - Country:US
Mailing Address - Phone:757-314-7944
Mailing Address - Fax:
Practice Address - Street 1:BLDG 557 STERNBERG AVENUE
Practice Address - Street 2:FT EUSTIS DENTAC
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-5311
Practice Address - Country:US
Practice Address - Phone:757-314-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17543122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist