Provider Demographics
NPI:1659668291
Name:PLATT, HEATHER JANNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:JANNA
Last Name:PLATT
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 1:133 S PLAINFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-4033
Mailing Address - Country:US
Mailing Address - Phone:908-322-2244
Mailing Address - Fax:
Practice Address - Street 1:133 S PLAINFIELD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-4033
Practice Address - Country:US
Practice Address - Phone:908-322-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038980122300000X
NJ22DI024744001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist