Provider Demographics
NPI:1841728771
Name:MENDL, HEATHER A (RDH)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
Last Name:MENDL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 5TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1827
Mailing Address - Country:US
Mailing Address - Phone:303-663-4366
Mailing Address - Fax:
Practice Address - Street 1:610 5TH ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1826
Practice Address - Country:US
Practice Address - Phone:303-663-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003106124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist