Healthcare Provider Details

I. General information

NPI: 1235227430
Provider Name (Legal Business Name): JEFF HEMMINGSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DUNES DENTAL 4 KIDS

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N SIOUX POINT RD STE 100
DAKOTA DUNES SD
57049-5067
US

IV. Provider business mailing address

711 N SIOUX POINT RD STE 100
DAKOTA DUNES SD
57049-5067
US

V. Phone/Fax

Practice location:
  • Phone: 605-242-4700
  • Fax: 605-242-4702
Mailing address:
  • Phone: 605-242-4700
  • Fax: 605-242-4702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number07988
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: