| Organization Name: | ANNANDALE DENTAL CLINIC PC |
| NPI Number: | 1083917363 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANTHONY DAVID HEGGE (OWNER/PRESIDENT) |
| Mailing Address: | 93 Oak Ave S Unit #3 Annandale |
| State: | MN US |
| Postal Code: | 553021205 |
| Phone Number: | 3202742475 |
| Fax Number: | 3202743152 |
| NPI Enumeration Date: | 12/08/2010 |
| NPI Last Update Date: | 12/08/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | D11795 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |