Individual provider Active NPI

Edwin Simon Kuipers, D.D.S.

  • General Practice Dentistry
  • Newark, DE
National Provider Identifier
1891003596
Registry record updated Sep 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
G1-0001156 Issued in DE
Practice address
210 W Park PL
Newark, DE 19711-4519
Phone
(302) 455-0333
Fax
(302) 368-3608
NPI assigned
Sep 16, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X G1-0001156 DE Primary

Addresses

Primary practice location

210 W Park PL
Newark, DE 19711-4519

Mailing address

300 Foulk Rd
Suite 101
Wilmington, DE 19803-3886
Phone (302) 652-3775

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151222000771 DE Order and Referring Only - DentistPractitioner - Dentist 4587965215

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Foulk Road Dental General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284595200000",
    "number": "1891003596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 FOULK RD",
            "address_2": "SUITE 101",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198033886",
            "telephone_number": "302-652-3775",
            "fax_number": "302-652-8423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W PARK PL",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197114519",
            "telephone_number": "302-455-0333",
            "fax_number": "302-368-3608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUIPERS",
        "first_name": "EDWIN",
        "middle_name": "SIMON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-16",
        "last_updated": "2010-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "DE",
            "license": "G1-0001156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.