Provider Demographics
NPI:1538357835
Name:DR. HEIDI'S KID'S DENTAL CENTER INC
Entity type:Organization
Organization Name:DR. HEIDI'S KID'S DENTAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:661-949-0120
Mailing Address - Street 1:43731 15TH ST W STE C
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4785
Mailing Address - Country:US
Mailing Address - Phone:661-949-0120
Mailing Address - Fax:661-942-2370
Practice Address - Street 1:43731 15TH ST W STE C
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4785
Practice Address - Country:US
Practice Address - Phone:661-949-0120
Practice Address - Fax:661-942-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB38689-01Medicaid