Individual
DR. LEROY A KAMELCHUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1107 GLENEAGLES DR SW, HUNTSVILLE, AL 35801-6405
(256) 882-3312
(256) 882-9472
Mailing address
1107 GLENEAGLES DR SW, HUNTSVILLE, AL 35801-6405
(256) 882-3312
(256) 882-9472
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
20060
AL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
4438
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51527421
BLUE CROSS BLUE SHIELD
AL
Enumeration date
02/15/2007
Last updated
08/16/2012
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