Provider Demographics
NPI:1922367275
Name:BRAUN HEINZ, CASSONDRA LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:LYNN
Last Name:BRAUN HEINZ
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 1:4904 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2864
Mailing Address - Country:US
Mailing Address - Phone:605-335-8640
Mailing Address - Fax:
Practice Address - Street 1:4904 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2864
Practice Address - Country:US
Practice Address - Phone:605-335-8640
Practice Address - Fax:605-332-9956
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13097122300000X
SDD1069122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist