Provider Demographics
NPI:1750940318
Name:NIEMEYER, KELLI C (DDS)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:C
Last Name:NIEMEYER
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 1:4000 LARAMIE STREET
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001
Mailing Address - Country:US
Mailing Address - Phone:307-426-4014
Mailing Address - Fax:307-426-4016
Practice Address - Street 1:4000 LARAMIE STREET
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:307-426-4014
Practice Address - Fax:307-426-4016
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002040201223G0001X
WY15511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice