Healthcare Provider Details

I. General information

NPI: 1215597414
Provider Name (Legal Business Name): MATTHEW KUIPER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3857 COOPER ST
JACKSON MI
49201-7547
US

IV. Provider business mailing address

4773 US HIGHWAY 131 N
BOYNE FALLS MI
49713-9617
US

V. Phone/Fax

Practice location:
  • Phone: 517-780-5760
  • Fax:
Mailing address:
  • Phone: 616-914-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901600113
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: