Provider Demographics
NPI:1922089499
Name:KUEMERLE, GLENN JOSEPH (DDS)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:JOSEPH
Last Name:KUEMERLE
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 1:33398 WALKER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1496
Mailing Address - Country:US
Mailing Address - Phone:440-933-4486
Mailing Address - Fax:440-930-4681
Practice Address - Street 1:33398 WALKER RD
Practice Address - Street 2:SUITE A
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1496
Practice Address - Country:US
Practice Address - Phone:440-933-4486
Practice Address - Fax:440-930-4681
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18775122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2442566Medicaid