Kyle James Siemen, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-3403 Issued in ID

Practice address

333 W Cedar St
Pocatello, ID 83201-5045

Phone

(208) 233-6912

Fax

(208) 233-6921

NPI assigned

Aug 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kyle James Siemen, D.M.D., P.a.

  dba Sage Dental

  • Dentist
  • Pocatello, ID
  • NPI 1285044529
  NPD (past) Authorized official

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952311078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4653 MOUNTAIN PARK RD",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832021702",
            "telephone_number": "208-478-8705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 W CEDAR ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015045",
            "telephone_number": "208-233-6912",
            "fax_number": "208-233-6921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEMEN",
        "first_name": "KYLE",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alex Michael Shreiber, PHARMD
• Shudl LLC
• Tyrone Richard Shuman, LCSW
• Chad Glen Sibbett, PA
• Randy C Sidwell, PT, MS, ATC
• Haiden L Siepert, ATC, LAT
• Chelsea Lee Silbernagel
• Troy Charles Siler
• Abigail Simister
• Steven Boe Simmons, PA-C

• 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.