Provider Demographics
NPI:1891003596
Name:KUIPERS, EDWIN SIMON (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:SIMON
Last Name:KUIPERS
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 1:300 FOULK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3886
Mailing Address - Country:US
Mailing Address - Phone:302-652-3775
Mailing Address - Fax:302-652-8423
Practice Address - Street 1:210 W PARK PL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4519
Practice Address - Country:US
Practice Address - Phone:302-455-0333
Practice Address - Fax:302-368-3608
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00011561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice