Provider Demographics
NPI:1629783428
Name:RANTALA, HEATHER P (RDH)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:P
Last Name:RANTALA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:P
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-3709
Mailing Address - Country:US
Mailing Address - Phone:715-394-5411
Mailing Address - Fax:715-392-5086
Practice Address - Street 1:2222 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-3709
Practice Address - Country:US
Practice Address - Phone:715-394-5411
Practice Address - Fax:715-392-5086
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH10112124Q00000X
WI1002945124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist