Provider Demographics
NPI:1457735482
Name:KEMMER, KRISTEN (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KEMMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 EASTCASTLE DR SE STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-8872
Mailing Address - Country:US
Mailing Address - Phone:616-281-0220
Mailing Address - Fax:616-281-8333
Practice Address - Street 1:2017 EASTCASTLE DR SE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-8872
Practice Address - Country:US
Practice Address - Phone:616-281-0220
Practice Address - Fax:616-281-8333
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64768122300000X
MI2901022527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist