Provider Demographics
NPI:1588191993
Name:HEMANN, MITCHELL CORY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:CORY
Last Name:HEMANN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 26TH AVE SE UNIT 512
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-4329
Mailing Address - Country:US
Mailing Address - Phone:507-272-9665
Mailing Address - Fax:
Practice Address - Street 1:3507 ROUND LAKE BLVD NW STE 900
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-4908
Practice Address - Country:US
Practice Address - Phone:763-323-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics