Provider Demographics
NPI:1093195224
Name:HEIDI FLETCHER, PLLC
Entity Type:Organization
Organization Name:HEIDI FLETCHER, PLLC
Other - Org Name:PILLAGER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-746-4555
Mailing Address - Street 1:727 BUCKSKIN AVE W
Mailing Address - Street 2:
Mailing Address - City:PILLAGER
Mailing Address - State:MN
Mailing Address - Zip Code:56473-2509
Mailing Address - Country:US
Mailing Address - Phone:218-746-4555
Mailing Address - Fax:
Practice Address - Street 1:727 BUCKSKIN AVE W
Practice Address - Street 2:
Practice Address - City:PILLAGER
Practice Address - State:MN
Practice Address - Zip Code:56473-2509
Practice Address - Country:US
Practice Address - Phone:218-746-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND125581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty