Provider Demographics
NPI:1336350412
Name:KINNUNEN, HEATHER MARIE (RDH)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:KINNUNEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53272 CO RD D
Mailing Address - Street 2:
Mailing Address - City:GRAND VIEW
Mailing Address - State:WI
Mailing Address - Zip Code:54839
Mailing Address - Country:US
Mailing Address - Phone:715-763-3118
Mailing Address - Fax:
Practice Address - Street 1:225 OSTERMANN DR
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54889-9191
Practice Address - Country:US
Practice Address - Phone:715-986-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6401-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33803200Medicare ID - Type UnspecifiedRDH