Provider Demographics
NPI:1124313424
Name:MARKS, HEATHER ROSE (DDS)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ROSE
Last Name:MARKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ROSE
Other - Last Name:MENSING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-0106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1030 RIVERPLACE DRIVE
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001
Practice Address - Country:US
Practice Address - Phone:715-268-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI67131223G0001X
MND129321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice