Basic Information
| Provider Information | |||||||||
| NPI: | 1255410973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HELLER | ||||||||
| FirstName: | RODNEY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187286445 | ||||||||
| FaxNumber: | 2187247003 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187286445 | ||||||||
| FaxNumber: | 2187247003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 10/30/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 8457 | MN | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
ID Information
| ID | Type | State | Issuer | Description | 904481008106 | 01 | MN | PREFERRED ONE | OTHER | 820436 | 01 | MN | UNITED CONCORDIA | OTHER |