Provider Demographics
NPI:1326618869
Name:MEGHANNE KRUIZENGA, DDS APC
Entity Type:Organization
Organization Name:MEGHANNE KRUIZENGA, DDS APC
Other - Org Name:MEGHANNE KRUIZENGA, DDS APC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGHANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUIZENGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-572-8010
Mailing Address - Street 1:1204 W CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6539
Mailing Address - Country:US
Mailing Address - Phone:951-572-8010
Mailing Address - Fax:
Practice Address - Street 1:1202 BEAUMONT AVE STE B
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-1506
Practice Address - Country:US
Practice Address - Phone:951-283-5827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty