Provider Demographics
NPI:1184732828
Name:HEATHER HOSSEINI DDS PA
Entity type:Organization
Organization Name:HEATHER HOSSEINI DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-389-9500
Mailing Address - Street 1:1040 WESTON RD
Mailing Address - Street 2:STE 225
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:954-389-9500
Mailing Address - Fax:954-384-1045
Practice Address - Street 1:1040 WESTON RD
Practice Address - Street 2:STE 225
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326
Practice Address - Country:US
Practice Address - Phone:954-389-9500
Practice Address - Fax:954-384-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty