Provider Demographics
NPI:1346628377
Name:LINDELL KEMMET,DDS PC DBA KEMMET DENTAL DESIGN
Entity Type:Organization
Organization Name:LINDELL KEMMET,DDS PC DBA KEMMET DENTAL DESIGN
Other - Org Name:KEMMET DENTAL DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDELL
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:KEMMET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-852-4789
Mailing Address - Street 1:1015 S BROADWAY
Mailing Address - Street 2:SUITE 24
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4667
Mailing Address - Country:US
Mailing Address - Phone:701-852-4789
Mailing Address - Fax:701-852-7273
Practice Address - Street 1:1015 S BROADWAY
Practice Address - Street 2:SUITE 24
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4667
Practice Address - Country:US
Practice Address - Phone:701-852-4789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND21251223G0001X
ND23031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty