Provider Demographics
NPI:1497890263
Name:HERTELENDY, DAVID WILLIAMS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAMS
Last Name:HERTELENDY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 NOBLE DR N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4156
Mailing Address - Country:US
Mailing Address - Phone:952-522-5136
Mailing Address - Fax:
Practice Address - Street 1:4221 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4129
Practice Address - Country:US
Practice Address - Phone:952-924-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND101711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice