Healthcare Provider Details

I. General information

NPI: 1760377873
Provider Name (Legal Business Name): PEYTON POLLY KUCHENBECKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N SYCAMORE AVE
SIOUX FALLS SD
57110-5740
US

IV. Provider business mailing address

105 E REDWOOD CIR UNIT 2
BRANDON SD
57005-1106
US

V. Phone/Fax

Practice location:
  • Phone: 605-338-6118
  • Fax:
Mailing address:
  • Phone: 605-415-3603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD1485
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: