Provider Demographics
NPI:1134251226
Name:WINTHER, HEATHER DEANNA (DDS)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:DEANNA
Last Name:WINTHER
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 1:4148 INGLEWOOD BLVD APT 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-7808
Mailing Address - Country:US
Mailing Address - Phone:310-391-2885
Mailing Address - Fax:
Practice Address - Street 1:4001 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-2739
Practice Address - Country:US
Practice Address - Phone:323-581-4008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice