Provider Demographics
NPI:1083823843
Name:KAMRATH, HEIDI LOU (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LOU
Last Name:KAMRATH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16466 BERNARDO CENTER DR
Mailing Address - Street 2:SUITE 176
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2508
Mailing Address - Country:US
Mailing Address - Phone:858-676-6709
Mailing Address - Fax:858-676-6739
Practice Address - Street 1:16466 BERNARDO CENTER DR
Practice Address - Street 2:SUITE 176
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2508
Practice Address - Country:US
Practice Address - Phone:858-676-6709
Practice Address - Fax:858-676-6739
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412651223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics