Provider Demographics
NPI:1669994372
Name:MEDEROS, HEIDI (DMD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:MEDEROS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17773 SW 152ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-7762
Mailing Address - Country:US
Mailing Address - Phone:305-910-8644
Mailing Address - Fax:
Practice Address - Street 1:100 NW 82ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1834
Practice Address - Country:US
Practice Address - Phone:954-358-4260
Practice Address - Fax:954-323-2600
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN227591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery