Provider Demographics
NPI:1467419390
Name:HIEB, RICHARD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:HIEB
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 1:810 E ROSSER AVE
Mailing Address - Street 2:STE 404
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4463
Mailing Address - Country:US
Mailing Address - Phone:701-222-0033
Mailing Address - Fax:701-222-8830
Practice Address - Street 1:810 E ROSSER AVE
Practice Address - Street 2:STE 404
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4463
Practice Address - Country:US
Practice Address - Phone:701-222-0033
Practice Address - Fax:701-222-8830
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND17341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND971734OtherDENTAL SERVICE CORP/BCBS
ND41197Medicaid
ND82000674OtherUNKNOWN INSURANCE CO.
ND848790OtherUNITED CONCORDIA INS.