Provider Demographics
NPI:1306345319
Name:HEEKE, JOSEPHINE MICHELLE (RDH)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:MICHELLE
Last Name:HEEKE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MR
Other - First Name:JOSEPHINE
Other - Middle Name:MICHELLE
Other - Last Name:JACQUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:ALMONT
Mailing Address - State:MI
Mailing Address - Zip Code:48003-0446
Mailing Address - Country:US
Mailing Address - Phone:810-798-8585
Mailing Address - Fax:810-798-2381
Practice Address - Street 1:606 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALMONT
Practice Address - State:MI
Practice Address - Zip Code:48003-8553
Practice Address - Country:US
Practice Address - Phone:810-798-8585
Practice Address - Fax:810-798-2381
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902013967124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist