Provider Demographics
NPI:1235227430
Name:HEMMINGSEN, JEFF (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:HEMMINGSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DUNES
Other - Middle Name:
Other - Last Name:DENTAL 4 KIDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:711 N SIOUX POINT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5067
Mailing Address - Country:US
Mailing Address - Phone:605-242-4700
Mailing Address - Fax:605-242-4702
Practice Address - Street 1:711 N SIOUX POINT RD STE 100
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5067
Practice Address - Country:US
Practice Address - Phone:605-242-4700
Practice Address - Fax:605-242-4702
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079881223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0234450Medicaid
IA0234450Medicaid