Provider Demographics
NPI:1689072373
Name:KLOEPPEL, GWENDOLYN YVETTE (RDH)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:YVETTE
Last Name:KLOEPPEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:GWENDOLYN
Other - Middle Name:YVETTE
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:108 NEW GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1023
Mailing Address - Country:US
Mailing Address - Phone:270-769-1601
Mailing Address - Fax:270-765-7274
Practice Address - Street 1:108 NEW GLENDALE RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1023
Practice Address - Country:US
Practice Address - Phone:270-769-1601
Practice Address - Fax:270-765-7274
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2619124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist