Provider Demographics
NPI:1851001168
Name:HETTINGER FAMILY DENTAL, P.C.
Entity Type:Organization
Organization Name:HETTINGER FAMILY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRODY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-639-0448
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:HETTINGER
Mailing Address - State:ND
Mailing Address - Zip Code:58639-0469
Mailing Address - Country:US
Mailing Address - Phone:701-567-4032
Mailing Address - Fax:
Practice Address - Street 1:204 HIGHWAY 12 E
Practice Address - Street 2:
Practice Address - City:HETTINGER
Practice Address - State:ND
Practice Address - Zip Code:58639-9687
Practice Address - Country:US
Practice Address - Phone:701-567-4302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1588313134OtherNATIONAL PROVIDER IDENTIFIER