Provider Demographics
NPI:1073736211
Name:WOLBACH, HEATHER E (DMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:E
Last Name:WOLBACH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:E
Other - Last Name:GORMLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1701
Mailing Address - Country:US
Mailing Address - Phone:781-659-7442
Mailing Address - Fax:
Practice Address - Street 1:317 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1701
Practice Address - Country:US
Practice Address - Phone:781-659-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry