Healthcare Provider Details

I. General information

NPI: 1932883501
Provider Name (Legal Business Name): KENNETH HARLAN KUYPER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 WASHINGTON AVE
IOWA FALLS IA
50126-1742
US

IV. Provider business mailing address

1907 WASHINGTON AVE
IOWA FALLS IA
50126-1742
US

V. Phone/Fax

Practice location:
  • Phone: 641-648-9364
  • Fax:
Mailing address:
  • Phone: 641-648-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-10090
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: