Provider Demographics
NPI:1245723394
Name:THORSON, HEATHER ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANN
Last Name:THORSON
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 1:119 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:NE
Mailing Address - Zip Code:68041-3078
Mailing Address - Country:US
Mailing Address - Phone:402-480-3538
Mailing Address - Fax:
Practice Address - Street 1:20211 MANDERSON ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3234
Practice Address - Country:US
Practice Address - Phone:402-505-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE74661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice