Provider Demographics
NPI:1326318643
Name:ANDREW F. HEIDERGOTT, DDS, PS
Entity Type:Organization
Organization Name:ANDREW F. HEIDERGOTT, DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:F
Authorized Official - Last Name:HEIDERGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-466-6979
Mailing Address - Street 1:10121 N NEVADA ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-3120
Mailing Address - Country:US
Mailing Address - Phone:509-466-6979
Mailing Address - Fax:509-466-0731
Practice Address - Street 1:10121 N NEVADA ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-3120
Practice Address - Country:US
Practice Address - Phone:509-466-6979
Practice Address - Fax:509-466-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601074651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty