Provider Demographics
NPI:1164613923
Name:DAUB, HEIDI ANN (DDS)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:DAUB
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:N63W23401 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3235
Mailing Address - Country:US
Mailing Address - Phone:262-246-6806
Mailing Address - Fax:
Practice Address - Street 1:N63W23401 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3235
Practice Address - Country:US
Practice Address - Phone:262-246-6806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI58911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice