Provider Demographics
NPI:1356578645
Name:HIEMSTRA, AUDRA LEANN (DDS)
Entity type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:LEANN
Last Name:HIEMSTRA
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 1:16510 DUNLEITH CIR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4832
Mailing Address - Country:US
Mailing Address - Phone:281-389-2720
Mailing Address - Fax:
Practice Address - Street 1:14090 FM 2920 RD STE H
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-5550
Practice Address - Country:US
Practice Address - Phone:281-516-1222
Practice Address - Fax:866-204-0120
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24722122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist