Healthcare Provider Details

I. General information

NPI: 1548250178
Provider Name (Legal Business Name): PAMELA GRIMSBO KAPPLE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S JEFFERSON ST
SIGOURNEY IA
52591-1516
US

IV. Provider business mailing address

214 S JEFFERSON ST PO BOX 214
SIGOURNEY IA
52591-1516
US

V. Phone/Fax

Practice location:
  • Phone: 641-622-3752
  • Fax: 641-622-2428
Mailing address:
  • Phone: 641-622-3752
  • Fax: 641-622-2428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6539
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: