Provider Demographics
NPI:1700046570
Name:HARRIS, HEATHER ANN (DDS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:HARRIS
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 1:4125 N. 124 ST, STE J
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:414-771-1228
Mailing Address - Fax:414-476-2515
Practice Address - Street 1:4125 N. 124 ST, STE J
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:414-771-1228
Practice Address - Fax:414-476-2515
Is Sole Proprietor?:No
Enumeration Date:2008-06-14
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6238-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice