Provider Demographics
NPI:1578971339
Name:HRUSKOCY, HEATHER NICOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:NICOLE
Last Name:HRUSKOCY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2617
Mailing Address - Country:US
Mailing Address - Phone:224-416-3780
Mailing Address - Fax:
Practice Address - Street 1:1089 CONWAY RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2617
Practice Address - Country:US
Practice Address - Phone:224-416-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029810122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist