Provider Demographics
NPI:1265925739
Name:RHODES, HEATHER NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:NICOLE
Last Name:RHODES
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 1:4545 MEADOWBROOK ST
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77662-8902
Mailing Address - Country:US
Mailing Address - Phone:469-667-8772
Mailing Address - Fax:
Practice Address - Street 1:2548 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2825
Practice Address - Country:US
Practice Address - Phone:469-667-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34076122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist