Provider Demographics
NPI:1780989038
Name:DR. KYNAN WESTERMEYER, DDS, PLLC
Entity type:Organization
Organization Name:DR. KYNAN WESTERMEYER, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTERMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-389-3320
Mailing Address - Street 1:404 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-1602
Mailing Address - Country:US
Mailing Address - Phone:763-389-3320
Mailing Address - Fax:763-631-0662
Practice Address - Street 1:404 1ST ST. N
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371
Practice Address - Country:US
Practice Address - Phone:763-389-3320
Practice Address - Fax:763-631-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11514261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental