# KEMP DENTAL LLC

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

## Provider details

- **NPI number:** 1255503777
- **Authorized official:** MR. SID ELLIS HEDGES DGMA (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (208) 232-6400

## Contact information

- **Practice address:** 1541 E CLARK ST, POCATELLO, ID 83201-4100
- **Practice address phone:** (208) 232-6400
- **Practice address fax:** (208) 232-6050
- **Mailing address:** 1541 E CLARK ST, POCATELLO, ID 83201-4100
- **Mailing address phone:** (208) 232-6400
- **Mailing address fax:** (208) 232-6050

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D-1783 | ID | Yes |

## Other

- **Enumeration date:** 03/25/2008
- **Last updated:** 03/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0025307 | — | ID |