Provider Demographics
NPI:1932580438
Name:KAPP, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KAPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8166 ROBIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-3086
Mailing Address - Country:US
Mailing Address - Phone:812-853-0853
Mailing Address - Fax:
Practice Address - Street 1:8166 ROBIN HILL RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-3086
Practice Address - Country:US
Practice Address - Phone:812-853-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012335A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist