Organization
RICHARD F HETTINGER
Active
Other names
The Dental Depot
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD F HETTINGER D.D.S. (OWNER)
(712) 239-5812
Entity
Organization
Contact information
Practice address
3900 FLOYD BLVD, SIOUX CITY, IA 51108-1552
(712) 239-5812
(712) 239-0662
Mailing address
3900 FLOYD BLVD, SIOUX CITY, IA 51108-1552
(712) 239-5812
(712) 239-0662
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6429
IA
1223G0001X
General Practice Dentistry
7590
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0166330
—
IA
Enumeration date
04/03/2007
Last updated
06/24/2008
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