Provider Demographics
NPI:1760485965
Name:KAMPFE, MARK IRIWN (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:IRIWN
Last Name:KAMPFE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:IRWIN
Other - Last Name:KAMPFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2900 DOOLITTLE DR BLDG 6000
Mailing Address - Street 2:RM 1TB03 ELLSWORTH AFB
Mailing Address - City:ELLSWORTH AFB
Mailing Address - State:SD
Mailing Address - Zip Code:57706-4821
Mailing Address - Country:US
Mailing Address - Phone:605-385-3560
Mailing Address - Fax:605-385-3498
Practice Address - Street 1:2900 DOOLITTLE DR BLDG 6000
Practice Address - Street 2:RM 1TB03 ELLSWORTH AFB
Practice Address - City:ELLSWORTH AFB
Practice Address - State:SD
Practice Address - Zip Code:57706-4821
Practice Address - Country:US
Practice Address - Phone:605-385-3560
Practice Address - Fax:605-385-3498
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA64811223G0001X
NE53991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6481OtherDDS LICENSE NUMBER
NE5399OtherDDS LICENSE NUMBER