Provider Demographics
NPI:1710501085
Name:HEIEN, HOLLY JOY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:JOY
Last Name:HEIEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-1717
Mailing Address - Country:US
Mailing Address - Phone:605-224-7345
Mailing Address - Fax:
Practice Address - Street 1:720 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-1717
Practice Address - Country:US
Practice Address - Phone:605-224-7345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD12601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice