Provider Demographics
NPI:1235512906
Name:HONG, HEATHER RENEE (DDS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:HONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:RENEE
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5994 S HOLLY ST # 140
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4221
Mailing Address - Country:US
Mailing Address - Phone:626-823-9740
Mailing Address - Fax:
Practice Address - Street 1:3690 S YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237
Practice Address - Country:US
Practice Address - Phone:303-695-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61761122300000X
MO2020031410122300000X
CADDS1049221223P0300X
ORD112411223P0300X
CO2034201223P0300X
MADN1856936122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist