Provider Demographics
NPI:1871747865
Name:LUEBBEN, HEATHER JOAN HEATHCOTE (ADT, RDH)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JOAN HEATHCOTE
Last Name:LUEBBEN
Suffix:
Gender:F
Credentials:ADT, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8960 SPRINGBROOK DRIVE NW
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5852
Mailing Address - Country:US
Mailing Address - Phone:763-784-7570
Mailing Address - Fax:763-785-8960
Practice Address - Street 1:8600 NICOLLET AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2824
Practice Address - Country:US
Practice Address - Phone:529-541-2888
Practice Address - Fax:952-541-2889
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH6785124Q00000X
MNDT4125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist
No124Q00000XDental ProvidersDental Hygienist