Healthcare Provider Details

I. General information

NPI: 1639868508
Provider Name (Legal Business Name): ASHLEY LINDA HEIKKILA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3088 WHITE BEAR AVE N
SAINT PAUL MN
55109-1312
US

IV. Provider business mailing address

12504 NORWAY CIR
BURNSVILLE MN
55337-3468
US

V. Phone/Fax

Practice location:
  • Phone: 651-315-1839
  • Fax:
Mailing address:
  • Phone: 195-225-5995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD14984
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: