WILLIAM W HEITZMAN (NPI# 1134564552) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134564552 |
| Entity Type | Individual |
| Full Name | WILLIAM W HEITZMAN |
| Practice Address |
415 1st Ave E Shakopee MN 55379-1439 |
| Practice Telephone | 9524035149 |
| Practice Fax Number | 9524035969 |
| Mailing Telephone | (952) 403-5149 |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 125J00000X | Dental Therapist | DT18 | MN | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 701 25th Ave S Ste 400, Minneapolis, MN 554541443 | 6126594908 |
| Street Address |
415 1ST AVE E |
| City | SHAKOPEE |
| State | MN |
| Zip Code | 55379-1439 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659332252 | Alan Charles Perry | Dentist | 415 1st Ave E, Shakopee, MN 55379-1439 | 2006-03-31 |
| 1295971299 | Shakopee Valley Family Dental Care, P.a. | Clinic/Center | 415 1st Ave E, Shakopee, MN 55379-1439 | 2008-12-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073123030 | True North Community Dental Clinic, LLC | Dentist | 415 East First Avenue, Shakopee, MN 55379 | 2020-08-05 |
| 1154988236 | Benedictine Living Community of Shakopee LLC | Assisted Living Facility | 1705 Windermere Way, Shakopee, MN 55379 | 2019-05-23 |
| 1346741394 | Expressions In Motion LLC | Speech-Language Pathologist | 1221 East 4th Ave., Shakopee, MN 55379 | 2018-02-26 |
| 1124529334 | A.m Dental Professionals P.a | Clinic/Center | 1036 1st Ave E, Shakopee, MN 55379 | 2018-02-22 |
| 1538522024 | Jesse Sylvester | Chiropractor | 1275 Ramsey Street South, #600, Shakopee, MN 55379 | 2016-04-01 |
| 1376903963 | Dakota Best Transportation LLC | Non-emergency Medical Transport (VAN) | 449 Dakota Street Apt 2, Shakopee, MN 55379 | 2016-02-25 |
| 1568856631 | Tatyana Mishkin Gleyzer | Nurse Practitioner | 1010 West Sixth Avenue, Shakopee, MN 55379 | 2015-03-26 |
| 1245634039 | Kalli Ledel | Pharmacist | 1198 Vierling Dr, Cub Pharmacy, Shakopee, MN 55379 | 2014-10-22 |
| 1487992913 | Jennifer Elizabeth Boyd | Nurse Practitioner | Pediatrics 1415 St Francis Ave, Park Nicollet Clinic-shakopee, Shakopee, MN 55379 | 2013-01-17 |
| 1013253798 | Acts Therapy LLC | Counselor | 8170 Old Carriage Court North, 215, Shakopee, MN 55379 | 2012-12-27 |
| Find all providers in zip 55379 | ||||
| Taxonomy Code | 125J00000X |
| Grouping | Dental Providers |
| Classification | Dental Therapist |
| A Dental Therapist is an individual who has completed an accredited or non-accredited dental therapy program and who has been authorized by the relevant state board or a tribal entity to provide services within the scope of their practice under the supervision of a dentist. Functions that may be delegated to the dental therapist vary based on the needs of the dentist, the educational preparation of the dental therapist and state dental practice acts and regulations. |
| Notes: Source: Summarized from Minnesota Statute 150A.105. [7/1/2012: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487264446 | Amber Nichelle Irby | Dental Therapist | 903 W Center St #130, Rochester, MN 55902 | 2020-08-05 |
| 1558835942 | Jennifer Iacobelli | Dental Therapist | 13899 Highway 13 South Frontage Road, Savage, MN 55378 | 2019-01-18 |
| 1992288781 | Katie Ask | Dental Therapist | 13889 Highway 13 S, Frontage Rd, Savage, MN 55378 | 2018-09-08 |
| 1487154092 | Sunny Moon | Dental Therapist | 10584 France Ave S, Bloomington, MN 55431-3538 | 2018-02-20 |
| 1326548454 | Julie Bonham | Dental Therapist | 803 3rd St. Se, Suite 330, Little Falls, MN 56345 | 2018-02-15 |
| 1376077974 | Saritha Gajawada | Dental Therapist | 15354 Plumstone Dr, Eden Prairie, MN 55347-2061 | 2017-04-20 |
| 1649644063 | Brittany Gronland | Dental Therapist | 25730 Smithtown Rd, Excelsior, MN 55331-8592 | 2015-11-23 |
| 1124405857 | Jenna Susanne Marquardt | Dental Therapist | 209 South 1st Street, Montevideo, MN 56265 | 2015-05-01 |
| 1558751495 | Weston Mark Schmidt | Dental Therapist | 411 East Howard St., Jacobson Family Dentistry PC, Hibbing, MN 55746 | 2015-01-30 |
| 1003230137 | Janelle Jehn | Dental Therapist | 4342 4th Ave S, Minneapolis, MN 55409-2155 | 2014-02-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.