Provider Demographics
NPI:1215559745
Name:KEMPAINEN, AMANDA LINN (DMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LINN
Last Name:KEMPAINEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MOEN DR
Mailing Address - Street 2:
Mailing Address - City:CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12921-3421
Mailing Address - Country:US
Mailing Address - Phone:518-569-9773
Mailing Address - Fax:
Practice Address - Street 1:5872 S 900 E STE 252
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1678
Practice Address - Country:US
Practice Address - Phone:801-278-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12192582-99211223G0001X
390200000X
UT12192582-99241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program