Healthcare Provider Details

I. General information

NPI: 1437223435
Provider Name (Legal Business Name): DEAN D HEUER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 78TH AVE N
BROOKLYN PARK MN
55445-2720
US

IV. Provider business mailing address

6901 78TH AVE N
BROOKLYN PARK MN
55445-2720
US

V. Phone/Fax

Practice location:
  • Phone: 763-561-5148
  • Fax: 763-561-2794
Mailing address:
  • Phone: 763-561-5148
  • Fax: 763-561-2794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9717
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: