| Kemp Dental Llc | |
|
1541 E Clark St Pocatello ID 83201-4100 | |
| (208) 232-6400 | |
| (208) 232-6050 |
| Full Name | Kemp Dental Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1541 E Clark St, Pocatello, Idaho |
| Authorized Official Name and Position | Sid Ellis Hedges (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 2082326400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kemp Dental Llc 1541 E Clark St Pocatello ID 83201-4100 Ph: (208) 232-6400 | Kemp Dental Llc 1541 E Clark St Pocatello ID 83201-4100 Ph: (208) 232-6400 |
| NPI Number | 1255503777 |
|---|---|
| Provider Enumeration Date | 03/25/2008 |
| Last Update Date | 03/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255503777 | NPI | - | NPPES |
| 0025307 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D-1783 (Idaho) | Primary |
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