Provider Demographics
NPI:1447773494
Name:LIEN, HEIDI L
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:LIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N PAIUTE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-6181
Mailing Address - Country:US
Mailing Address - Phone:435-586-1112
Mailing Address - Fax:
Practice Address - Street 1:157 N RESERVATION DR
Practice Address - Street 2:
Practice Address - City:KANOSH
Practice Address - State:UT
Practice Address - Zip Code:84637
Practice Address - Country:US
Practice Address - Phone:435-759-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9850489-9920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9850489-9920OtherDENTAL HYGIENE LICENSE