Provider Demographics
NPI:1598844276
Name:HEITNER, JUDSON W (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:W
Last Name:HEITNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6608 FLYING CLOUD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3381
Mailing Address - Country:US
Mailing Address - Phone:952-903-5000
Mailing Address - Fax:952-944-0642
Practice Address - Street 1:6608 FLYING CLOUD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3381
Practice Address - Country:US
Practice Address - Phone:952-903-5000
Practice Address - Fax:952-944-0642
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN96851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice