NPIMap

Organization Active NPI

Richard F Hettinger

  • General Practice Dentistry
  • Sioux City, IA
National Provider Identifier
1053432047
Registry record updated Jun 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6429 Issued in IA
Legal business name
RICHARD F HETTINGER
Practice address
3900 Floyd Blvd
Sioux City, IA 51108-1552
Phone
(712) 239-5812
Fax
(712) 239-0662
NPI assigned
Apr 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Richard F Hettinger, D.D.S.NPI 1750591160
Title
Owner
Phone
(712) 239-5812

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 6429 IA Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 7590 IA

Addresses

Primary practice location

3900 Floyd Blvd
Sioux City, IA 51108-1552

Mailing address

3900 Floyd Blvd
Sioux City, IA 51108-1552
Phone (712) 239-5812

Other identifiers 1

IdentifierTypeStateIssuer
0166330MedicaidIA

Other names 1

  • The Dental Depot Doing business as

National Provider Directory

National Provider Directory

Locations

3900 Floyd Blvd
Sioux City, IA 51108
Phone (712) 239-5812

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1053432047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 FLOYD BLVD",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511081552",
            "telephone_number": "712-239-5812",
            "fax_number": "712-239-0662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 FLOYD BLVD",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511081552",
            "telephone_number": "712-239-5812",
            "fax_number": "712-239-0662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD F HETTINGER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "HETTINGER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "712-239-5812",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "6429",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "7590",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0166330",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Dental Depot",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.