Organization
WHITEWATER ORAL SURGERY GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN GLENN KEMPERS MD, DDS (OWNER)
(208) 342-7610
Entity
Organization
Contact information
Practice address
3003 W MAIN ST STE 130, BOISE, ID 83702-2026
(208) 342-7610
(208) 344-1799
Mailing address
3003 W MAIN ST STE 130, BOISE, ID 83702-2026
(208) 342-7610
(208) 344-1799
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D3407
ID
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
M7750
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805496900
—
ID
05
—
805511300
—
ID
Enumeration date
01/13/2014
Last updated
09/04/2020
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