Healthcare Provider Details

I. General information

NPI: 1619296019
Provider Name (Legal Business Name): CHELSEA RENEE KUIPERS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N SYCAMORE AVE
SIOUX FALLS SD
57110-5740
US

IV. Provider business mailing address

720 N SYCAMORE AVE
SIOUX FALLS SD
57110-5740
US

V. Phone/Fax

Practice location:
  • Phone: 605-338-6118
  • Fax: 605-335-4798
Mailing address:
  • Phone: 605-338-6118
  • Fax: 605-335-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDO936
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: