Provider Demographics
NPI:1982866497
Name:SAFRAN, HEATHER LEE (RDH)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:LEE
Last Name:SAFRAN
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 1:15636 101ST ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3202
Mailing Address - Country:US
Mailing Address - Phone:718-344-9194
Mailing Address - Fax:
Practice Address - Street 1:1663 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6003
Practice Address - Country:US
Practice Address - Phone:718-768-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025245124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist