Provider Demographics
NPI:1932329638
Name:HERITAGE DENTAL CARE LTD
Entity Type:Organization
Organization Name:HERITAGE DENTAL CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:EHRESMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-645-9543
Mailing Address - Street 1:2011 JEFFERSON ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-3159
Mailing Address - Country:US
Mailing Address - Phone:507-645-9543
Mailing Address - Fax:507-645-5612
Practice Address - Street 1:2011 JEFFERSON ROAD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-3159
Practice Address - Country:US
Practice Address - Phone:507-645-9543
Practice Address - Fax:507-645-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND88791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty