Provider Demographics
NPI:1407958317
Name:MEYER, KAMP RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMP
Middle Name:RICHARD
Last Name:MEYER
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 1:2620 JACKSON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702
Mailing Address - Country:US
Mailing Address - Phone:605-343-1500
Mailing Address - Fax:605-343-0196
Practice Address - Street 1:2620 JACKSON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702
Practice Address - Country:US
Practice Address - Phone:605-343-1500
Practice Address - Fax:605-343-0196
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM4591223X0400X
WY8081223X0400X
CO1042291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics