Healthcare Provider Details

I. General information

NPI: 1265589642
Provider Name (Legal Business Name): KUIPERS ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 PENN AVE S SUITE 216
BLOOMINGTON MN
55431-2068
US

IV. Provider business mailing address

8900 PENN AVE S SUITE 216
BLOOMINGTON MN
55431-2068
US

V. Phone/Fax

Practice location:
  • Phone: 952-884-9161
  • Fax:
Mailing address:
  • Phone: 952-884-9161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7434
License Number StateMN

VIII. Authorized Official

Name: PETER W KUIPERS
Title or Position: OWNER
Credential: DDS PHD
Phone: 952-884-9161