| NPI | 1104248053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN GLENN KEMPERS Owner 208-342-7610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ID D3407) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ID M7750) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2020-09-04 |