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General NPI Number Information
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NPI Number | 1760377873
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Entity Type | Individual
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Provider Name | PEYTON POLLY KUCHENBECKER DDS
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Gender | Female
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 720 N SYCAMORE AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57110-5740
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Country | US
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Telephone | 605-338-6118
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Fax |
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Provider Business Mailing Address
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Address Line | 105 E REDWOOD CIR UNIT 2
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City | BRANDON
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State | SD
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Zip | 57005-1106
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Country | US
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Telephone | 605-415-3603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D1485
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License Number State | SD
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