{"npi":"1104248053","type":"NPI-2","status":"active","name":{"display":"Whitewater Oral Surgery Group PLLC","other":[],"organization_name":"WHITEWATER ORAL SURGERY GROUP PLLC","authorised_official":"Kevin Kempers"},"specialty":{"primary_taxonomy":"1223S0112X","primary_taxonomy_description":"Oral and Maxillofacial Surgery (Dentist)","slug":"oral-and-maxillofacial-surgery-dentist","schema_org_specialty":null,"all":[{"code":"1223S0112X","description":"Oral and Maxillofacial Surgery (Dentist)","primary":false,"state":"ID","license":"M7750"},{"code":"1223S0112X","description":"Oral and Maxillofacial Surgery (Dentist)","primary":true,"state":"ID","license":"D3407"}]},"addresses":[{"purpose":"LOCATION","street_1":"3003 W MAIN ST STE 130","city":"BOISE","state":"ID","postal_code":"837022026","country_code":"US","phone":"2083427610","fax":"2083441799"},{"purpose":"MAILING","street_1":"3003 W MAIN ST STE 130","city":"BOISE","state":"ID","postal_code":"837022026","country_code":"US","phone":"2083427610","fax":"2083441799"}],"license":{"state":"ID","number":"D3407"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"805496900","state":"ID","issuer":null},{"type_code":"05","label":"Medicaid","value":"805511300","state":"ID","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20200928002448","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"ID","pac_id":"4789009473"}]},"enumeration_date":"2014-01-13","last_updated":"2020-09-04","_meta":{"source":"NPPES","snapshot_date":"2020-09-04","doc_url":"https://findmynpi.com/api"}}