Active NPI
Larry J Kemp, D.D.S.
- General Practice Dentistry
- Pocatello, ID
National Provider Identifier
1407951262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D-1783
- Practice address
- 1541 E Clark St
Pocatello, ID 83201-4100 - Phone
- (208) 232-6400
- Fax
- (208) 232-6050
- NPI assigned
- Sep 14, 2006
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D-1783 | ID | Primary |
Addresses
Primary practice location
1541 E Clark St
Pocatello, ID 83201-4100
Mailing address
1541 E Clark St
Pocatello, ID 83201-4100
Phone (208) 232-6400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0025307 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-1783 | ID | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1407951262",
"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": {
"last_name": "KEMP",
"first_name": "LARRY",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-09",
"status": "A"
},
"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": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.