Provider Demographics
NPI:1780972711
Name:MELANIE L KEMMERER, DMD, PLLC
Entity type:Organization
Organization Name:MELANIE L KEMMERER, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KEMMERER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-514-9159
Mailing Address - Street 1:110 SUWANNEE AVE SW
Mailing Address - Street 2:P.O. BOX 930
Mailing Address - City:BRANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32008-2749
Mailing Address - Country:US
Mailing Address - Phone:386-935-0988
Mailing Address - Fax:386-935-0989
Practice Address - Street 1:110 SUWANNEE AVE SW
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:FL
Practice Address - Zip Code:32008-2749
Practice Address - Country:US
Practice Address - Phone:386-935-0988
Practice Address - Fax:386-935-0989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17680261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental