Provider Demographics
NPI:1205566924
Name:HEATHER PHARES, DDS, PC
Entity type:Organization
Organization Name:HEATHER PHARES, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:PHARES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-861-5905
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:NEW ERA
Mailing Address - State:MI
Mailing Address - Zip Code:49446-0036
Mailing Address - Country:US
Mailing Address - Phone:231-861-5905
Mailing Address - Fax:
Practice Address - Street 1:4711 1ST ST
Practice Address - Street 2:
Practice Address - City:NEW ERA
Practice Address - State:MI
Practice Address - Zip Code:49446-5100
Practice Address - Country:US
Practice Address - Phone:231-861-5905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental