Provider Demographics
NPI:1487744439
Name:CAPPELEN, KEVIN DOUGLAS (DDS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DOUGLAS
Last Name:CAPPELEN
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 1:719 CRESTA CIR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33413-1047
Mailing Address - Country:US
Mailing Address - Phone:561-689-6915
Mailing Address - Fax:
Practice Address - Street 1:16110 JOG RD
Practice Address - Street 2:101
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2350
Practice Address - Country:US
Practice Address - Phone:561-381-4056
Practice Address - Fax:561-381-5163
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist