Provider Demographics
NPI:1821374828
Name:MUNCHEL, KELLY KATHRYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:KATHRYN
Last Name:MUNCHEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3673 FREMANTLE DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3070
Mailing Address - Country:US
Mailing Address - Phone:561-634-1399
Mailing Address - Fax:
Practice Address - Street 1:691 ALDERMAN RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2602
Practice Address - Country:US
Practice Address - Phone:727-724-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist