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General NPI Number Information
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NPI Number | 1326618869
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Entity Type | Organization
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Legal Business Name | MEGHANNE KRUIZENGA, DDS APC
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 1202 BEAUMONT AVE STE B
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City | BEAUMONT
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State | CA
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Zip | 92223-1506
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Country | US
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Telephone | 951-283-5827
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 W CRESCENT AVE
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City | REDLANDS
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State | CA
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Zip | 92373-6539
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Country | US
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Telephone | 951-572-8010
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | MEGHANNE KRUIZENGA
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Credential | DDS
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Telephone | 951-572-8010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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