Provider Demographics
NPI:1639607112
Name:HOLTON, HEATHER VANNUIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:VANNUIL
Last Name:HOLTON
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 1:4770 N 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-5577
Mailing Address - Country:US
Mailing Address - Phone:616-405-7003
Mailing Address - Fax:
Practice Address - Street 1:5813 BALSAM DR
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-1104
Practice Address - Country:US
Practice Address - Phone:616-669-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010222321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice