Provider Demographics
NPI:1689629321
Name:BLACHLEY, HEIDI LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LYNN
Last Name:BLACHLEY
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 1:1475 BOYSON ROAD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2339
Mailing Address - Country:US
Mailing Address - Phone:319-393-4019
Mailing Address - Fax:319-378-2924
Practice Address - Street 1:1475 BOYSON ROAD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2339
Practice Address - Country:US
Practice Address - Phone:319-393-4019
Practice Address - Fax:319-378-2924
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA76381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1123307Medicaid
IA51276OtherWELLMARK
IA124986OtherUNITED CONCORDIA