Provider Demographics
NPI:1750803839
Name:MULDER, HEATHER DIANE (RDH)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DIANE
Last Name:MULDER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DIANE
Other - Last Name:LORIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:906 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-7829
Mailing Address - Country:US
Mailing Address - Phone:920-980-9144
Mailing Address - Fax:
Practice Address - Street 1:1721 SAEMANN AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-2342
Practice Address - Country:US
Practice Address - Phone:920-783-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11221-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist