Provider Demographics
NPI:1295419505
Name:HEDLUND, DESIRAE (DDS)
Entity type:Individual
Prefix:
First Name:DESIRAE
Middle Name:
Last Name:HEDLUND
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 1:1213 W NISHNA RD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-2115
Mailing Address - Country:US
Mailing Address - Phone:712-246-2180
Mailing Address - Fax:712-246-1683
Practice Address - Street 1:1213 W NISHNA RD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-2115
Practice Address - Country:US
Practice Address - Phone:712-246-2180
Practice Address - Fax:712-246-1683
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice