Whitewater Oral Surgery Group PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D3407 Issued in ID

Legal business name

WHITEWATER ORAL SURGERY GROUP PLLC

Practice address

3003 W Main St Ste 130
Boise, ID 83702-2026

Phone

(208) 342-7610

Fax

(208) 344-1799

NPI assigned

Jan 13, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin Glenn Kempers, MD, DDSNPI 1255435459

Title

Owner

Phone

(208) 342-7610

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul Kenneth Clark III, D.M.D, M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Twin Falls, ID
  • NPI 1689994923
  Medicare reassignment NPD
• Kevin G Kempers, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Boise, ID
  • NPI 1255435459
  NPD Authorized official
• Christopher Scott Manis Jr., DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Boise, ID
  • NPI 1770945479

  Oral and Maxillofacial Surgery

  NPD
• Devan Michael Munk, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Boise, ID
  • NPI 1255968053
  NPD
• Justin Hastings, DDS, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Boise, ID
  • NPI 1831496843
  NPD (past)
• Bruce Morrison, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Boise, ID
  • NPI 1790892610
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599177600000",
    "number": "1104248053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 W MAIN ST STE 130",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837022026",
            "telephone_number": "208-342-7610",
            "fax_number": "208-344-1799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 W MAIN ST STE 130",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837022026",
            "telephone_number": "208-342-7610",
            "fax_number": "208-344-1799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITEWATER ORAL SURGERY GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-13",
        "last_updated": "2020-09-04",
        "certification_date": "2020-09-04",
        "status": "A",
        "authorized_official_last_name": "KEMPERS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-342-7610",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "D3407",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "M7750",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805496900",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805511300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Whitenack, PT
• Linda Ann Whitener, FAMILY NURSE PRACTIT
• Jackie J Whitesell, MD
• James H Whiteside, MD
• Paul D Whitesides, O.D.
• Whitewater TMS LLC
• Jared Whiting, CRNA
• Katherine Wannetta Kapua Whiting, LMFT, MS
• Auston Whitmer, APRN, FNP
• Katelyn Whitmer

• Oral and Maxillofacial Surgery (Dentist) in Boise, ID
• Providers in Boise, ID by specialty
• Oral and Maxillofacial Surgery (Dentist) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.