Provider Demographics
NPI:1902617103
Name:HETTINGER FAMILY DENTAL, P.C.
Entity type:Organization
Organization Name:HETTINGER FAMILY DENTAL, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRODY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-639-0448
Mailing Address - Street 1:2 1ST ST W STE 215
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5106
Mailing Address - Country:US
Mailing Address - Phone:701-483-6999
Mailing Address - Fax:
Practice Address - Street 1:2 1ST ST W STE 215
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5106
Practice Address - Country:US
Practice Address - Phone:701-483-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HETTINGER FAMILY DENTAL, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1588313134OtherINDIVIDUAL NPI