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General NPI Number Information
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NPI Number | 1780989038
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Entity Type | Organization
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Legal Business Name | DR. KYNAN WESTERMEYER, DDS, PLLC
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 404 1ST ST. N
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City | PRINCETON
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State | MN
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Zip | 55371
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Country | US
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Telephone | 763-389-3320
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Fax | 763-631-0662
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Provider Business Mailing 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 | 763-631-0662
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Authorized Official
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Title or Position | CHIEF MANAGER
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Name | DR. KYNAN WESTERMEYER
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Credential | DDS
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Telephone | 763-389-3320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 11514
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License Number State | MN
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