Provider Demographics
NPI:1912005075
Name:KEMNITZ, KEITH ALLAN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALLAN
Last Name:KEMNITZ
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 COUNTY ROAD 42 W
Mailing Address - Street 2:SUITE 138
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-6994
Mailing Address - Country:US
Mailing Address - Phone:952-894-1365
Mailing Address - Fax:952-894-9602
Practice Address - Street 1:2999 COUNTY ROAD 42 W
Practice Address - Street 2:SUITE 138
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-6994
Practice Address - Country:US
Practice Address - Phone:952-894-1365
Practice Address - Fax:952-894-9602
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND94461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics