Individual
MARK IRIWN KAMPFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2900 DOOLITTLE DR BLDG 6000, RM 1TB03 ELLSWORTH AFB, ELLSWORTH AFB, SD 57706-4821
(605) 385-3560
(605) 385-3498
Mailing address
2900 DOOLITTLE DR BLDG 6000, RM 1TB03 ELLSWORTH AFB, ELLSWORTH AFB, SD 57706-4821
(605) 385-3560
(605) 385-3498
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5399
NE
1223G0001X
General Practice Dentistry
6481
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5399
DDS LICENSE NUMBER
NE
01
—
6481
DDS LICENSE NUMBER
IA
Enumeration date
05/23/2005
Last updated
08/05/2010
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