Provider Demographics
NPI:1790433647
Name:HEISER, NICOLE (RDH)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:HEISER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W225S6665 GUTHRIE RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-9571
Mailing Address - Country:US
Mailing Address - Phone:262-716-1828
Mailing Address - Fax:
Practice Address - Street 1:W225S6665 GUTHRIE RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-9571
Practice Address - Country:US
Practice Address - Phone:262-716-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty