Provider Demographics
NPI:1316089394
Name:KEMLAGE, THOMAS F (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:KEMLAGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 SMIZER STATION RD.
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3290
Mailing Address - Country:US
Mailing Address - Phone:636-225-1777
Mailing Address - Fax:636-225-4777
Practice Address - Street 1:1576 SMIZER STATION RD.
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3290
Practice Address - Country:US
Practice Address - Phone:636-225-1777
Practice Address - Fax:636-225-4777
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO148711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice