Provider Demographics
NPI:1790200509
Name:HOUSEHOLTER, HEATHER NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:NICOLE
Last Name:HOUSEHOLTER
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 1:22600 VENTURA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1461
Mailing Address - Country:US
Mailing Address - Phone:818-225-0046
Mailing Address - Fax:
Practice Address - Street 1:22600 VENTURA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1461
Practice Address - Country:US
Practice Address - Phone:818-483-4388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1016051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice