Provider Demographics
NPI:1730473133
Name:HRADEK, HEATHER H (DDS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:H
Last Name:HRADEK
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 1:751 E PORTER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9111
Mailing Address - Country:US
Mailing Address - Phone:219-929-9289
Mailing Address - Fax:219-929-9289
Practice Address - Street 1:751 E PORTER AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-9110
Practice Address - Country:US
Practice Address - Phone:219-929-9289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011617A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist