# WHITEWATER ORAL SURGERY GROUP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104248053
- **Authorized official:** DR. KEVIN GLENN KEMPERS MD, DDS (OWNER)
- **Authorized official phone:** (208) 342-7610

## Contact information

- **Practice address:** 3003 W MAIN ST STE 130, BOISE, ID 83702-2026
- **Practice address phone:** (208) 342-7610
- **Practice address fax:** (208) 344-1799
- **Mailing address:** 3003 W MAIN ST STE 130, BOISE, ID 83702-2026
- **Mailing address phone:** (208) 342-7610
- **Mailing address fax:** (208) 344-1799

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | D3407 | ID | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | M7750 | ID | — |

## Other

- **Enumeration date:** 01/13/2014
- **Last updated:** 09/04/2020