Provider Demographics
NPI:1619356631
Name:HEATHER DESH ORTHODONTICS, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:HEATHER DESH ORTHODONTICS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:HD ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DESH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-762-0997
Mailing Address - Street 1:354 LOMA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-2745
Mailing Address - Country:US
Mailing Address - Phone:610-762-0997
Mailing Address - Fax:
Practice Address - Street 1:4714 E LOS COYOTES DIAGONAL
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2825
Practice Address - Country:US
Practice Address - Phone:562-283-6590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA616401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty