Provider Demographics
NPI:1669607719
Name:KAPPENMAN DENTAL CLINIC LTD
Entity type:Organization
Organization Name:KAPPENMAN DENTAL CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPPENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-361-9288
Mailing Address - Street 1:5704 W 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-1011
Mailing Address - Country:US
Mailing Address - Phone:605-361-9288
Mailing Address - Fax:605-361-1909
Practice Address - Street 1:5704 W 41ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-1011
Practice Address - Country:US
Practice Address - Phone:605-361-9288
Practice Address - Fax:605-361-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM7911223G0001X
SDM6931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty