Kemp Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-1783 Issued in ID

Legal business name

KEMP DENTAL LLC

Practice address

1541 E Clark St
Pocatello, ID 83201-4100

Phone

(208) 232-6400

Fax

(208) 232-6050

NPI assigned

Mar 25, 2008

Last updated

Mar 25, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Sid Ellis Hedges, DGMA

Title

Practice Administrator

Phone

(208) 232-6400

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206403200000",
    "number": "1255503777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 E CLARK ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014100",
            "telephone_number": "208-232-6400",
            "fax_number": "208-232-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 E CLARK ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014100",
            "telephone_number": "208-232-6400",
            "fax_number": "208-232-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEMP DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-25",
        "last_updated": "2008-03-25",
        "status": "A",
        "authorized_official_last_name": "HEDGES",
        "authorized_official_first_name": "SID",
        "authorized_official_middle_name": "ELLIS",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "208-232-6400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DGMA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-1783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0025307",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katrina Louise Keady
• Colby Russell Kearl, MD
• Darci J Kearn
• Justin Thomas Keate, RN
• Benjamin Kellum, DDS
• Larry J Kemp, D.D.S.
• Kendra Westerhaus PHD LLC
• Titus Kener
• Robert Michael Kennedy, M.D.
• Kenneth P. Lindsey, PHD, PA

• General Practice Dentistry in Pocatello, ID
• Providers in Pocatello, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.