1902968530 NPI number — DR. ANNALEE SUSAN KRUYER DDS, FAGD

Table of content: DR. ANNALEE SUSAN KRUYER DDS, FAGD (NPI 1902968530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902968530 NPI number — DR. ANNALEE SUSAN KRUYER DDS, FAGD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRUYER
Provider First Name:
ANNALEE
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, FAGD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902968530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8925 W RUSSELL RD
Provider Second Line Business Mailing Address:
SUITE #160
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89148-1219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-732-2223
Provider Business Mailing Address Fax Number:
702-433-2247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8925 W RUSSELL RD
Provider Second Line Business Practice Location Address:
SUITE #160
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-732-2223
Provider Business Practice Location Address Fax Number:
702-433-2247
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4574 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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