Provider Demographics
NPI:1710067350
Name:HECKMAN-NICKODEMUS, KRISTIN FRANCINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:FRANCINE
Last Name:HECKMAN-NICKODEMUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:FRANCINE
Other - Last Name:HECKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:323 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4133
Mailing Address - Country:US
Mailing Address - Phone:734-623-7798
Mailing Address - Fax:
Practice Address - Street 1:2240 S HURON PKWY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5151
Practice Address - Country:US
Practice Address - Phone:734-677-2156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010176701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice