Provider Demographics
NPI:1821281049
Name:PAHLS, HEIDI (DDS, MS)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:PAHLS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 N CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:COQUILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97423-1244
Mailing Address - Country:US
Mailing Address - Phone:541-396-1960
Mailing Address - Fax:
Practice Address - Street 1:346 N CENTRAL ST
Practice Address - Street 2:
Practice Address - City:COQUILLE
Practice Address - State:OR
Practice Address - Zip Code:97423-1244
Practice Address - Country:US
Practice Address - Phone:541-396-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD86511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry