Organization
HETTINGER FAMILY DENTAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRODY W PETERSON DDS (PRESIDENT/OWNER)
(605) 639-0448
Entity
Organization
Contact information
Practice address
204 HIGHWAY 12 E, HETTINGER, ND 58639-9687
(701) 567-4302
Mailing address
PO BOX 469, HETTINGER, ND 58639-0469
(701) 567-4032
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1588313134
NATIONAL PROVIDER IDENTIFIER
ND
Enumeration date
11/28/2022
Last updated
01/15/2025
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