Provider Demographics
NPI:1245265503
Name:KEGLER, CLARENCE CORNELL II (DDS)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:CORNELL
Last Name:KEGLER
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3772 SATELLITE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5681
Mailing Address - Country:US
Mailing Address - Phone:770-476-9511
Mailing Address - Fax:770-623-1923
Practice Address - Street 1:3772 SATELLITE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5681
Practice Address - Country:US
Practice Address - Phone:770-476-9511
Practice Address - Fax:770-623-1923
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN 0123761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice