Provider Demographics
NPI:1760377873
Name:KUCHENBECKER, PEYTON POLLY (DDS)
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:POLLY
Last Name:KUCHENBECKER
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 1:105 E REDWOOD CIR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-1106
Mailing Address - Country:US
Mailing Address - Phone:605-415-3603
Mailing Address - Fax:
Practice Address - Street 1:720 N SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-5740
Practice Address - Country:US
Practice Address - Phone:605-338-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD390200000X
SDD1485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program