Provider Demographics
NPI:1376665265
Name:SKARI, HEATHER LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:SKARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:GEISZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4110 40TH ST S STE 103
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-3907
Mailing Address - Country:US
Mailing Address - Phone:701-293-7996
Mailing Address - Fax:701-293-1296
Practice Address - Street 1:4110 40TH ST S STE 103
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-3907
Practice Address - Country:US
Practice Address - Phone:701-293-7996
Practice Address - Fax:701-293-1296
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND1916122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist