Provider Demographics
NPI:1891141933
Name:MOELLERS, HEATHER NICOLE NANCY SCHAKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:NICOLE NANCY SCHAKE
Last Name:MOELLERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:NICOLE NANCY
Other - Last Name:SCHAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:75 SHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552-1468
Mailing Address - Country:US
Mailing Address - Phone:715-762-0200
Mailing Address - Fax:
Practice Address - Street 1:75 SHERRY AVE
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552-1468
Practice Address - Country:US
Practice Address - Phone:715-762-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-08
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI1001357-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program