Organization
KYLE JAMES SIEMEN, D.M.D., P.A.
Active
Other names
Sage Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYLE JAMES SIEMEN D.M.D (DENTIST/PRESIDENT)
(208) 233-6912
Entity
Organization
Contact information
Practice address
333 W CEDAR ST, POCATELLO, ID 83201-5045
(208) 233-6912
(208) 233-6921
Mailing address
333 W CEDAR ST, POCATELLO, ID 83201-5045
(208) 233-6912
(208) 233-6921
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3403
ID
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
05/07/2014
Last updated
05/07/2014
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