Provider Demographics
NPI:1316667462
Name:ROOT CANAL SPECIALISTS NORTH, PLLC
Entity type:Organization
Organization Name:ROOT CANAL SPECIALISTS NORTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTICS/C.F.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMPER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:616-361-6609
Mailing Address - Street 1:4355 SAWKAW DR. NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1768
Mailing Address - Country:US
Mailing Address - Phone:616-361-6609
Mailing Address - Fax:616-361-6248
Practice Address - Street 1:4355 SAWKAW DR. NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1768
Practice Address - Country:US
Practice Address - Phone:616-361-6609
Practice Address - Fax:616-361-6248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty