Provider Demographics
NPI:1215316633
Name:HOOGEVEEN, KAITLIN JOY (DDS)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:JOY
Last Name:HOOGEVEEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:JOY
Other - Last Name:BEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-0228
Mailing Address - Country:US
Mailing Address - Phone:712-722-5565
Mailing Address - Fax:712-722-5566
Practice Address - Street 1:164 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1536
Practice Address - Country:US
Practice Address - Phone:712-722-5565
Practice Address - Fax:712-722-5566
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-093731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty