Provider Demographics
NPI:1306030069
Name:KEHM, WAYNE H II (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:H
Last Name:KEHM
Suffix:II
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8108
Mailing Address - Country:US
Mailing Address - Phone:727-321-4850
Mailing Address - Fax:727-323-1679
Practice Address - Street 1:4850 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8108
Practice Address - Country:US
Practice Address - Phone:727-321-4850
Practice Address - Fax:727-323-1679
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL58651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice