Provider Demographics
NPI:1396157921
Name:KMETZSCH, CAMERON (DMD)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:
Last Name:KMETZSCH
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 1:6610 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-7953
Mailing Address - Country:US
Mailing Address - Phone:772-567-7510
Mailing Address - Fax:772-567-3578
Practice Address - Street 1:6610 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-7953
Practice Address - Country:US
Practice Address - Phone:772-567-7510
Practice Address - Fax:772-567-3578
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist