Provider Demographics
NPI:1548250178
Name:KAPPLE, PAMELA GRIMSBO (DDS)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:GRIMSBO
Last Name:KAPPLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 S JEFFERSON ST
Mailing Address - Street 2:PO BOX 214
Mailing Address - City:SIGOURNEY
Mailing Address - State:IA
Mailing Address - Zip Code:52591-1516
Mailing Address - Country:US
Mailing Address - Phone:641-622-3752
Mailing Address - Fax:641-622-2428
Practice Address - Street 1:214 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SIGOURNEY
Practice Address - State:IA
Practice Address - Zip Code:52591-1516
Practice Address - Country:US
Practice Address - Phone:641-622-3752
Practice Address - Fax:641-622-2428
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA224733OtherDELTA OF IA SATELLITE
IA0500041Medicaid
IA177287OtherDELTA OF IA PRIMARY
IA1500041Medicaid