Organization
KEMP DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SID ELLIS HEDGES DGMA (PRACTICE ADMINISTRATOR)
(208) 232-6400
Entity
Organization
Contact information
Practice address
1541 E CLARK ST, POCATELLO, ID 83201-4100
(208) 232-6400
(208) 232-6050
Mailing address
1541 E CLARK ST, POCATELLO, ID 83201-4100
(208) 232-6400
(208) 232-6050
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-1783
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0025307
—
ID
Enumeration date
03/25/2008
Last updated
03/25/2008
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