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General NPI Number Information
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NPI Number | 1902617103
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Entity Type | Organization
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Legal Business Name | HETTINGER FAMILY DENTAL, P.C.
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 2 1ST ST W STE 215
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City | DICKINSON
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State | ND
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Zip | 58601-5106
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Country | US
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Telephone | 701-483-6999
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Fax |
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Provider Business Mailing Address
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Address Line | 2 1ST ST W STE 215
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City | DICKINSON
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State | ND
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Zip | 58601-5106
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Country | US
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Telephone | 701-483-6999
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRODY PETERSON
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Credential | DDS
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Telephone | 605-639-0448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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