Provider Demographics
NPI:1942844758
Name:HOUSTON, HEATHER ELAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ELAINE
Last Name:HOUSTON
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 1:31208 NICE AVE
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:CA
Mailing Address - Zip Code:92359-1390
Mailing Address - Country:US
Mailing Address - Phone:909-488-9026
Mailing Address - Fax:
Practice Address - Street 1:7223 CHURCH ST STE A6
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5811
Practice Address - Country:US
Practice Address - Phone:909-425-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1040741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice