Provider Demographics
NPI:1023795614
Name:SMITH, HEATHER R (RDHAP)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:R
Other - Last Name:KLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15208 SHERWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WEED
Mailing Address - State:CA
Mailing Address - Zip Code:96094-9364
Mailing Address - Country:US
Mailing Address - Phone:707-372-7466
Mailing Address - Fax:
Practice Address - Street 1:116 W MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:MCCLOUD
Practice Address - State:CA
Practice Address - Zip Code:96057
Practice Address - Country:US
Practice Address - Phone:530-964-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA996124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist