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General NPI Number Information
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NPI Number | 1275604597
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Entity Type | Individual
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Provider Name | KYNAN RICHARD WESTERMEYER DDS
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Gender | Male
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 404 1ST ST
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City | PRINCETON
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State | MN
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Zip | 55371-1602
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Country | US
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Telephone | 763-389-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 13808 213TH AVE NW
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City | ELK RIVER
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State | MN
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Zip | 55330-4680
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Country | US
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Telephone | 763-241-0455
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D11514
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License Number State | MN
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