Provider Demographics
NPI:1467724989
Name:ANDERSON, HEATHER MARIE (RDH)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:CREDENTIALING
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-0808
Mailing Address - Country:US
Mailing Address - Phone:509-935-6001
Mailing Address - Fax:509-935-4196
Practice Address - Street 1:509 E. MAIN AVENUE
Practice Address - Street 2:CREDENTIALING
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-0808
Practice Address - Country:US
Practice Address - Phone:509-935-6001
Practice Address - Fax:509-935-4196
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00006838124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist