Healthcare Provider Details

I. General information

NPI: 1740620285
Provider Name (Legal Business Name): TREVOR JAMES KUIPER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 S MAIN AVE
SIOUX CENTER IA
51250
US

IV. Provider business mailing address

1320 S MAIN AVE
SIOUX CENTER IA
51250-1103
US

V. Phone/Fax

Practice location:
  • Phone: 712-348-3247
  • Fax:
Mailing address:
  • Phone: 712-348-3247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number433
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-09479
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: