# KYLE JAMES SIEMEN, D.M.D., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sage Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285044529
- **Authorized official:** DR. KYLE JAMES SIEMEN D.M.D (DENTIST/PRESIDENT)
- **Authorized official phone:** (208) 233-6912

## Contact information

- **Practice address:** 333 W CEDAR ST, POCATELLO, ID 83201-5045
- **Practice address phone:** (208) 233-6912
- **Practice address fax:** (208) 233-6921
- **Mailing address:** 333 W CEDAR ST, POCATELLO, ID 83201-5045
- **Mailing address phone:** (208) 233-6912
- **Mailing address fax:** (208) 233-6921

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D3403 | ID | Yes |
| 332BC3200X | Customized Equipment (DME) | — | — | — |

## Other

- **Enumeration date:** 05/07/2014
- **Last updated:** 05/07/2014