Provider Demographics
NPI:1992993935
Name:RONNGREN, HEATHER R (DMD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:RONNGREN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 N MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3542
Mailing Address - Country:US
Mailing Address - Phone:406-755-4127
Mailing Address - Fax:
Practice Address - Street 1:1050 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3542
Practice Address - Country:US
Practice Address - Phone:406-755-4127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600618911223G0001X
MTDEN-DEN-LIC-115051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice