WHITEWATER ORAL SURGERY GROUP PLLC
NPI 1104248053
Dentist - Oral and Maxillofacial Surgery in Boise, ID

Q: What is Whitewater Oral Surgery Group PLLC's NPI number?

The NPI number for Whitewater Oral Surgery Group PLLC is 1104248053. It was assigned to this organization in the NPPES registry on January 13, 2014.

Q: What is Whitewater Oral Surgery Group PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Active since January 13, 2014

3003 W MAIN ST STE 130, BOISE, ID 83702(208) 342-7610(208) 344-1799 Get Directions Write a Review

NPPES record last updated: September 4, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 4, 2020, Apr 21, 2020 (2 updates tracked since 2020).

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About Whitewater Oral Surgery Group Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WHITEWATER ORAL SURGERY GROUP PLLC (NPI 1104248053) is a healthcare organization registered as an oral and maxillofacial surgery in Boise, Idaho and active in the NPI registry since January 2014. The organization lists Kevin Glenn Kempers, Owner, as its authorized official.

NPPES Registry Identity

NPI1104248053

Entity TypeOrganization

Primary Taxonomy1223S0112X

Legal Business NameWHITEWATER ORAL SURGERY GROUP PLLC

Location Address3003 W MAIN ST STE 130Boise, ID 83702-2026

Mailing Address3003 W Main St Ste 130Boise, ID 83702-2026 · (208) 342-7610 · Fax (208) 344-1799

Phone(208) 342-7610

Fax(208) 344-1799

Organization SubpartNo

Authorized OfficialKevin Glenn KempersOwner · (208) 342-7610

Enumeration DateJanuary 13, 2014

Last NPPES UpdateSeptember 4, 20202 updates tracked since enumeration

NPPES CertifiedSeptember 4, 2020

✔ NPI 1104248053 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

Licenses✔ Licensed in ID · D3407✔ Licensed in ID · M7750

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

3003 W MAIN ST STE 130, Boise, ID 83702

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Other Identifiers 2

Medicaid805496900ID

Medicaid805511300ID

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KEVIN G KEMPERS DDS, MD

Dentist (Oral and Maxillofacial Surgery)