Provider Demographics
NPI:1538167069
Name:KEMP, DAVID GLENN (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GLENN
Last Name:KEMP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 WINDER HWY
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-3021
Mailing Address - Country:US
Mailing Address - Phone:678-960-3440
Mailing Address - Fax:678-960-3445
Practice Address - Street 1:4030 WINDER HWY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3021
Practice Address - Country:US
Practice Address - Phone:678-960-3440
Practice Address - Fax:678-960-3445
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014012122300000X
FLDN 152981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice