Provider Demographics
NPI:1639464092
Name:PERDUE, HEATHER N (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:N
Last Name:PERDUE
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 1:1345 N JESSE JAMES RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1183
Mailing Address - Country:US
Mailing Address - Phone:816-630-5713
Mailing Address - Fax:816-630-0392
Practice Address - Street 1:1345 N JESSE JAMES RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1183
Practice Address - Country:US
Practice Address - Phone:816-630-5713
Practice Address - Fax:816-630-0392
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110163121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice