Provider Demographics
NPI:1841380946
Name:KEMP, MARK WINDSOR (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WINDSOR
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 1:1628 MEMORIAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-3596
Mailing Address - Country:US
Mailing Address - Phone:336-226-2271
Mailing Address - Fax:336-226-1665
Practice Address - Street 1:1628 MEMORIAL DR STE A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3596
Practice Address - Country:US
Practice Address - Phone:336-226-2271
Practice Address - Fax:336-226-1665
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC94840Medicaid