Provider Demographics
NPI:1932368412
Name:KRIDER, HEIDI J (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:J
Last Name:KRIDER
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 1:1001 CHESTNUT HILLS PKWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-8933
Mailing Address - Country:US
Mailing Address - Phone:260-625-5100
Mailing Address - Fax:260-625-5021
Practice Address - Street 1:1001 CHESTNUT HILLS PKWY
Practice Address - Street 2:SUITE 5
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-8933
Practice Address - Country:US
Practice Address - Phone:260-625-5100
Practice Address - Fax:260-625-5021
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010262A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist