Jack David Kemper, DMD
Individual provider Active NPI Dentist · Prospect, CT
NPI 1639701865 · NPPES record last updated Feb 5, 2020
Key facts
- NPI
- 1639701865
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 12688 (CT)
- Practice address
- 60 Waterbury Rd
Prospect, CT 06712-1250 - Phone
- (203) 527-3855
- NPI assigned
- Feb 5, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12688 | CT | Yes |
Addresses
Primary practice location
60 Waterbury Rd
Prospect, CT 06712-1250
Mailing address
154 Haven Ave Apt 1210
New York, NY 10032-1180
Phone (616) 644-1743
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | jdk2176@cumc.columbia.edu |
Other providers in Prospect, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.