Provider Demographics
NPI:1588054803
Name:KEMMLER, ALISON
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:KEMMLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 THOROUGHBRED CT
Mailing Address - Street 2:# 1031
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-5110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2715 THOROUGHBRED CT
Practice Address - Street 2:# 1031
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-5110
Practice Address - Country:US
Practice Address - Phone:804-314-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH071747124Q00000X
VA0402206521124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist