Provider Demographics
NPI:1386751592
Name:KALLIES, HEATHER MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARIE
Last Name:KALLIES
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 1:7560 BRUNS CT
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8747
Mailing Address - Country:US
Mailing Address - Phone:614-833-0260
Mailing Address - Fax:
Practice Address - Street 1:245 E 8TH ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3427
Practice Address - Country:US
Practice Address - Phone:740-775-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH216341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice