Healthcare Provider Details

I. General information

NPI: 1871663997
Provider Name (Legal Business Name): EDNA FAYE KEMP D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5660 CAITO DR BLDG 3 SUITE 130
INDIANAPOLIS IN
46226-1372
US

IV. Provider business mailing address

5660 CAITO DR BLDG 3 SUITE 130
INDIANAPOLIS IN
46226-1372
US

V. Phone/Fax

Practice location:
  • Phone: 317-545-5367
  • Fax: 317-545-6230
Mailing address:
  • Phone: 317-545-5367
  • Fax: 317-545-6230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12009358
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: