Provider Demographics
NPI:1508217878
Name:HEEMSKERK, KAISHA (DDS)
Entity Type:Individual
Prefix:
First Name:KAISHA
Middle Name:
Last Name:HEEMSKERK
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 1:350 E HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-5005
Mailing Address - Country:US
Mailing Address - Phone:515-777-7568
Mailing Address - Fax:515-777-7569
Practice Address - Street 1:350 E HICKMAN ROAD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263
Practice Address - Country:US
Practice Address - Phone:515-777-7568
Practice Address - Fax:515-777-7569
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA09315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist