Provider Demographics
NPI:1942494380
Name:STAUFFER, HEIDI A (DDS)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:STAUFFER
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 1:124 COUNTY LINE RD W
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7231
Mailing Address - Country:US
Mailing Address - Phone:614-882-2249
Mailing Address - Fax:
Practice Address - Street 1:124 COUNTY LINE RD W
Practice Address - Street 2:SUITE A
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7231
Practice Address - Country:US
Practice Address - Phone:614-882-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024161122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist