Provider Demographics
NPI:1043881105
Name:HIEMSTRA, KIANA MARIE CULLINAN (DDS)
Entity Type:Individual
Prefix:
First Name:KIANA
Middle Name:MARIE CULLINAN
Last Name:HIEMSTRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KIANA
Other - Middle Name:MARIE
Other - Last Name:CULLINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3617 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-4800
Mailing Address - Country:US
Mailing Address - Phone:641-529-2660
Mailing Address - Fax:
Practice Address - Street 1:820 2ND AVE N
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1761
Practice Address - Country:US
Practice Address - Phone:507-831-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND-147181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice