Provider Demographics
NPI:1316258338
Name:HIEGERT, AARON JOSEPH (DDS, MSD)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:JOSEPH
Last Name:HIEGERT
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 W KINGSHIGHWAY STE 4
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-2644
Mailing Address - Country:US
Mailing Address - Phone:870-393-5600
Mailing Address - Fax:870-393-5601
Practice Address - Street 1:2709 W KINGSHIGHWAY STE 4
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2644
Practice Address - Country:US
Practice Address - Phone:870-393-5600
Practice Address - Fax:870-393-5601
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010016287122300000X
CO10701122300000X
AR44681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69351074Medicaid
MO1316258338Medicaid
MO1930351596OtherBNDD
MOFH2153067OtherDEA