Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 2562 | FL |
NPI | 1164671368 |
---|---|
Provider Name | John Mitchell Kreher |
First Address | Melbourne, FL 32901 |
Second Address | Melbourne, FL 32901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2008 |
Last Update Date | 11/09/2008 |