Provider Demographics
NPI:1124450036
Name:KAEMMER, IAN JAMESON (DMD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:JAMESON
Last Name:KAEMMER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WILFORD HALL LOOP
Mailing Address - Street 2:
Mailing Address - City:JBSA LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5638
Mailing Address - Country:US
Mailing Address - Phone:210-292-9038
Mailing Address - Fax:
Practice Address - Street 1:59 DG-AF POSTGRADUATE DENTAL SCHOOL
Practice Address - Street 2:2133 PEPPERRELL ST. BLDG #3352
Practice Address - City:JBSA-LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-292-6258
Practice Address - Fax:210-292-2618
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.8272 GD122300000X
SCDGD.82721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist