Provider Demographics
NPI:1033229521
Name:UNDLIN STEVENS, HEIDI NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:NICOLE
Last Name:UNDLIN STEVENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:NICOLE
Other - Last Name:UNDLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:DAKOTA DENTAL ASSOCIATES PC
Mailing Address - Street 2:4000 17TH AVE S
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-775-0641
Mailing Address - Fax:701-746-9328
Practice Address - Street 1:DAKOTA DENTAL ASSOCIATES PC
Practice Address - Street 2:4000 17TH AVE S
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-775-0641
Practice Address - Fax:701-746-9328
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
788399OtherUNITED CONCORDIA
ND901931OtherDENTAL SERVICES CORP