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General NPI Number Information
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NPI Number | 1932329638
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Entity Type | Organization
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Legal Business Name | HERITAGE DENTAL CARE LTD
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2011 JEFFERSON ROAD
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City | NORTHFIELD
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State | MN
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Zip | 55057-3159
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Country | US
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Telephone | 507-645-9543
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Fax | 507-645-5612
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Provider Business Mailing Address
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Address Line | 2011 JEFFERSON ROAD
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City | NORTHFIELD
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State | MN
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Zip | 55057-3159
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Country | US
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Telephone | 507-645-9543
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Fax | 507-645-5612
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN H EHRESMANN
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Credential | D.D.S.
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Telephone | 507-645-9543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D8879
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License Number State | MN
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