Provider Demographics
NPI:1619025798
Name:KUIPERS ORTHODONTICS
Entity Type:Organization
Organization Name:KUIPERS ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:W
Authorized Official - Last Name:KUIPERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PHD
Authorized Official - Phone:952-892-3282
Mailing Address - Street 1:14000 NICOLLET AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5790
Mailing Address - Country:US
Mailing Address - Phone:952-892-3282
Mailing Address - Fax:952-892-3878
Practice Address - Street 1:14000 NICOLLET AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5790
Practice Address - Country:US
Practice Address - Phone:952-892-3282
Practice Address - Fax:952-892-3878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN74341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty