Provider Demographics
NPI:1437255940
Name:KAPPENMAN, JAY JAMES (DDS)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:JAMES
Last Name:KAPPENMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 E CENTENNIAL LN
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-5614
Mailing Address - Country:US
Mailing Address - Phone:605-371-1301
Mailing Address - Fax:
Practice Address - Street 1:5704 W 41ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-1011
Practice Address - Country:US
Practice Address - Phone:605-361-9288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM6931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice