Provider Demographics
NPI:1326407701
Name:HEIDI A. STAUFFER DDS
Entity Type:Organization
Organization Name:HEIDI A. STAUFFER DDS
Other - Org Name:STAUFFER FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-882-2249
Mailing Address - Street 1:124 COUNTY LINE RD W, SUITE A
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082
Mailing Address - Country:US
Mailing Address - Phone:614-882-2249
Mailing Address - Fax:
Practice Address - Street 1:124 COUNTY LINE RD W, SUITE A
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082
Practice Address - Country:US
Practice Address - Phone:614-882-2249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty