Provider Demographics
NPI:1235587023
Name:HEINE, NIKLAS FUQIANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIKLAS
Middle Name:FUQIANG
Last Name:HEINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1384 109TH AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4542
Mailing Address - Country:US
Mailing Address - Phone:763-757-6000
Mailing Address - Fax:
Practice Address - Street 1:1384 109TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4542
Practice Address - Country:US
Practice Address - Phone:763-757-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist