Provider Demographics
NPI:1457831760
Name:HEIMISDOTTIR, LARA HOLM (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:HOLM
Last Name:HEIMISDOTTIR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF NORTH CAROLINA SCHOOL OF DENTISTRY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-3426
Mailing Address - Country:US
Mailing Address - Phone:919-260-2845
Mailing Address - Fax:
Practice Address - Street 1:385 S COLUMBIA ST UNIVERSITY OF NORTH CAROLINA
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-537-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1512171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry