Healthcare Provider Details

I. General information

NPI: 1891003596
Provider Name (Legal Business Name): EDWIN SIMON KUIPERS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W PARK PL
NEWARK DE
19711-4519
US

IV. Provider business mailing address

300 FOULK RD SUITE 101
WILMINGTON DE
19803-3886
US

V. Phone/Fax

Practice location:
  • Phone: 302-455-0333
  • Fax: 302-368-3608
Mailing address:
  • Phone: 302-652-3775
  • Fax: 302-652-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberG1-0001156
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: