Provider Demographics
NPI:1780713149
Name:HEGGE, ANTHONY DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:DAVID
Last Name:HEGGE
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 1:93 OAK AVE S
Mailing Address - Street 2:SUITE #3 PO BOX 539
Mailing Address - City:ANNANDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55302-1205
Mailing Address - Country:US
Mailing Address - Phone:320-274-2475
Mailing Address - Fax:320-274-3152
Practice Address - Street 1:93 OAK AVE S
Practice Address - Street 2:SUITE #3
Practice Address - City:ANNANDALE
Practice Address - State:MN
Practice Address - Zip Code:55302-1205
Practice Address - Country:US
Practice Address - Phone:320-274-2475
Practice Address - Fax:320-274-3152
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND117951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice