Provider Demographics
NPI:1811639875
Name:HARRIS, HEATHER ANNE (BSDH)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 ETON RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1738
Mailing Address - Country:US
Mailing Address - Phone:540-857-7206
Mailing Address - Fax:
Practice Address - Street 1:3091 COLONIAL AVE SW # HP119
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-4705
Practice Address - Country:US
Practice Address - Phone:540-857-7206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402202555124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist