Provider Demographics
NPI:1972679066
Name:EHRESMANN, JOHN HENRY (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:EHRESMANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 JEFFERSON RD
Mailing Address - Street 2:HERITAGE DENTAL CARE LTD
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057
Mailing Address - Country:US
Mailing Address - Phone:507-645-9543
Mailing Address - Fax:507-645-5612
Practice Address - Street 1:2011 JEFFERSON RD
Practice Address - Street 2:HERITAGE DENTAL CARE LTD
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057
Practice Address - Country:US
Practice Address - Phone:507-645-9543
Practice Address - Fax:507-645-5612
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND88791223G0001X
CO1050541223G0001X
IA067521223G0001X
WI28930151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice