Organization
HEIDI M BRANDENBURG DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HEIDI MARIE BRANDENBURG DDS (OWNER)
(952) 922-8787
Entity
Organization
Contact information
Practice address
3948 W 50TH ST, STE 201, EDINA, MN 55424-1210
(952) 722-8787
(952) 922-5595
Mailing address
3948 W 50TH ST, STE 201, EDINA, MN 55424-1210
(952) 722-8787
(952) 922-5595
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10348
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
78956BR
BLUE CROSS/BLUE SHIELD
—
Enumeration date
08/04/2005
Last updated
03/22/2010
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