Provider Demographics
NPI:1952522591
Name:ADISKA, HEATHER MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MICHELLE
Last Name:ADISKA
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 1:2876 BROGAN RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:49285-9617
Mailing Address - Country:US
Mailing Address - Phone:734-777-9091
Mailing Address - Fax:517-851-8836
Practice Address - Street 1:100 WEST MAIN
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:MI
Practice Address - Zip Code:49285
Practice Address - Country:US
Practice Address - Phone:517-851-8008
Practice Address - Fax:517-851-8836
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist