Cassondra Lynn Braun Heinz, D.D.S.
Individual provider Active NPI Dentist · Sioux Falls, SD
NPI 1922367275 · NPPES record last updated Mar 24, 2021
Key facts
- NPI
- 1922367275
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D1069 (SD)
- Practice address
- 4904 S Minnesota Ave
Sioux Falls, SD 57108-2864 - Phone
- (605) 335-8640
- Fax
- (605) 332-9956
- NPI assigned
- May 7, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160509000920 | SD | Order and Referring Only - Other (Non-Physician) | 5395044648 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D13097 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aberdeen Dental | Past | Accepting new patients | |
| Motz DDS PC | Dentist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D13097 | MN | |
| Dentist | 122300000X | D1069 | SD | Yes |
Addresses
Primary practice location
4904 S Minnesota Ave
Sioux Falls, SD 57108-2864
Mailing address
4904 S Minnesota Ave
Sioux Falls, SD 57108-2864
Phone (605) 335-8640
Other providers in Sioux Falls, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.