Provider Demographics
NPI:1952463325
Name:KLEINHUIZEN, MERLIN N (DDS)
Entity Type:Individual
Prefix:
First Name:MERLIN
Middle Name:N
Last Name:KLEINHUIZEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 3RD ST SW
Mailing Address - Street 2:STE 1
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3385
Mailing Address - Country:US
Mailing Address - Phone:320-235-3440
Mailing Address - Fax:320-235-3602
Practice Address - Street 1:525 3RD ST SW
Practice Address - Street 2:STE 1
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3385
Practice Address - Country:US
Practice Address - Phone:320-235-3440
Practice Address - Fax:320-235-3602
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN69821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6982OtherLICENSE