Provider Demographics
NPI:1427024801
Name:BOKEMPER, RICHARD KEITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KEITH
Last Name:BOKEMPER
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:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-0280
Mailing Address - Country:US
Mailing Address - Phone:712-943-4242
Mailing Address - Fax:712-943-4243
Practice Address - Street 1:703 FIRST ST.
Practice Address - Street 2:
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-0280
Practice Address - Country:US
Practice Address - Phone:712-943-4242
Practice Address - Fax:712-943-4243
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA70091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA217992Medicaid
IA217992Medicare ID - Type Unspecified
IAU41182Medicare UPIN