Provider Demographics
NPI:1033088950
Name:TREML, HEATHER MAE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MAE
Last Name:TREML
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-1306
Mailing Address - Country:US
Mailing Address - Phone:920-965-0831
Mailing Address - Fax:920-965-0834
Practice Address - Street 1:1245 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-1306
Practice Address - Country:US
Practice Address - Phone:920-965-0831
Practice Address - Fax:920-965-0834
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6680-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist