Provider Demographics
NPI:1902115983
Name:KEMP, LILLIANE MARIE (RDH LAP)
Entity Type:Individual
Prefix:MS
First Name:LILLIANE
Middle Name:MARIE
Last Name:KEMP
Suffix:
Gender:F
Credentials:RDH LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38708 NATURES GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-9655
Mailing Address - Country:US
Mailing Address - Phone:541-746-4008
Mailing Address - Fax:
Practice Address - Street 1:38708 NATURES GARDEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-9655
Practice Address - Country:US
Practice Address - Phone:541-746-4008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4498124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist