Kevin Eugene Kemarly, D.M.D
Individual provider Active NPI Dentist · Malmstrom Afb, MT
NPI 1194078063 · NPPES record last updated Aug 21, 2023
Key facts
- NPI
- 1194078063
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019.029220 (IL)
- Practice address
- 7300 N Perimeter Rd
Malmstrom Afb, MT 59402 - Phone
- (067) 313-3184
- NPI assigned
- Oct 17, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.029220 | IL | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.029220 | IL | Yes |
Addresses
Primary practice location
7300 N Perimeter Rd
Malmstrom Afb, MT 59402
Mailing address
3278 Mitchell Blvd BLDG 900
Moody Afb, GA 31699-1500
Phone (229) 257-4304
Other providers in Malmstrom Afb, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.