Provider Demographics
NPI:1366859993
Name:ANDERSON, HEATHER MAUREEN STILLMAN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MAUREEN STILLMAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:MAUREEN
Other - Last Name:STILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1403 CENTRAL AVE WEST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525
Mailing Address - Country:US
Mailing Address - Phone:515-532-2529
Mailing Address - Fax:515-602-6400
Practice Address - Street 1:1403 CENTRAL AVE WEST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525
Practice Address - Country:US
Practice Address - Phone:515-532-2529
Practice Address - Fax:515-602-6400
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-091091223G0001X
IA091091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice