Healthcare Provider Details

I. General information

NPI: 1619025798
Provider Name (Legal Business Name): KUIPERS ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 NICOLLET AVE SUITE 300
BURNSVILLE MN
55337-5790
US

IV. Provider business mailing address

14000 NICOLLET AVE SUITE 300
BURNSVILLE MN
55337-5790
US

V. Phone/Fax

Practice location:
  • Phone: 952-892-3282
  • Fax: 952-892-3878
Mailing address:
  • Phone: 952-892-3282
  • Fax: 952-892-3878

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: 952-892-3282