Active NPI
Andrew Kemlage
- Dentist
- Fenton, MO
National Provider Identifier
1386057032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2014016811
- Practice address
- 1576 Smizer Station Rd
Fenton, MO 63026-3290 - Phone
- (636) 225-1777
- NPI assigned
- Jun 10, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2014016811 | MO | Primary |
Addresses
Primary practice location
1576 Smizer Station Rd
Fenton, MO 63026-3290
Mailing address
2417 Boardwalk PL
Saint Louis, MO 63129-4853
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402358400000",
"number": "1386057032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2417 BOARDWALK PL",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631294853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1576 SMIZER STATION RD",
"city": "FENTON",
"state": "MO",
"postal_code": "630263290",
"telephone_number": "636-225-1777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEMLAGE",
"first_name": "ANDREW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-10",
"last_updated": "2014-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2014016811",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.