Provider Demographics
NPI:1992835904
Name:KANNING, HEIDI K (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:K
Last Name:KANNING
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:483 W. HENDRICKSON
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-0236
Mailing Address - Country:US
Mailing Address - Phone:360-683-6172
Mailing Address - Fax:360-681-8075
Practice Address - Street 1:483 WEST HENDRICKSON
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-0236
Practice Address - Country:US
Practice Address - Phone:360-683-6172
Practice Address - Fax:360-681-8075
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA64201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics