Provider Demographics
NPI:1417013533
Name:NATIONS, HEATHER ALICE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ALICE
Last Name:NATIONS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:ALICE
Other - Last Name:WELLIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:421 SW OAK ST
Mailing Address - Street 2:STE.210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1817
Mailing Address - Country:US
Mailing Address - Phone:503-988-7468
Mailing Address - Fax:503-988-3015
Practice Address - Street 1:11540 NE INVERNESS DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9002
Practice Address - Country:US
Practice Address - Phone:503-988-5033
Practice Address - Fax:503-988-5030
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD84951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice