MEDICARE: KENNETH HARLAN KUYPER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DDS-10090	IA

General Provider Information

NPI Number	:	1932883501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH HARLAN KUYPER DDS

Provider Business Mailing Address
First Line	:	1907 WASHINGTON AVE
Second Line	:
City	:	IOWA FALLS
State	:	IA
Zip	:	50126-1742
Country	:	US
Telephone Number	:	641-648-9364
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 WASHINGTON AVE
Second Line	:
City	:	IOWA FALLS
State	:	IA
Zip	:	50126-1742
Country	:	US
Telephone Number	:	641-648-9364
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2023
Last Update Date	:	06/13/2023

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