Provider Demographics
NPI:1548038615
Name:KING, HEATHER (RDH)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:DE NOBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:413 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4611
Mailing Address - Country:US
Mailing Address - Phone:715-298-3983
Mailing Address - Fax:
Practice Address - Street 1:2633 DEVELOPMENT DR STE 40
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WI
Practice Address - Zip Code:54311-4239
Practice Address - Country:US
Practice Address - Phone:715-298-3983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11249-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist