Provider Demographics
NPI:1871648667
Name:HEINO, CARLA L (DDS)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:L
Last Name:HEINO
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 1:1425 E RUM RIVER DR S
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-2569
Mailing Address - Country:US
Mailing Address - Phone:763-689-7306
Mailing Address - Fax:763-689-7305
Practice Address - Street 1:1425 E RUM RIVER DR S
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-2569
Practice Address - Country:US
Practice Address - Phone:763-689-7306
Practice Address - Fax:763-689-7305
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11055122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist