Provider Demographics
NPI:1366895708
Name:KEMINK, MEGAN KATHLEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:KEMINK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 STATE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4312
Mailing Address - Country:US
Mailing Address - Phone:616-249-0159
Mailing Address - Fax:
Practice Address - Street 1:311 STATE ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4312
Practice Address - Country:US
Practice Address - Phone:616-249-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010219061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice