Provider Demographics
NPI:1871849927
Name:BRANDENBURG, HEIDI MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:BRANDENBURG
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 1:3948 W 50TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1210
Mailing Address - Country:US
Mailing Address - Phone:952-922-8787
Mailing Address - Fax:952-922-5595
Practice Address - Street 1:3948 W 50TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1210
Practice Address - Country:US
Practice Address - Phone:952-922-8787
Practice Address - Fax:952-922-5595
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN78956BROtherBLUE CROSS BLUE SHEILD