Provider Demographics
NPI:1386903631
Name:CANTORI, HEATHER LENORE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LENORE
Last Name:CANTORI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LENORE
Other - Last Name:MCBURNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:224 HAILI ST
Mailing Address - Street 2:BLDG B
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2975
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16-192 PILI MUA ST
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-8134
Practice Address - Country:US
Practice Address - Phone:808-930-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HI1951223D0001X
HI2504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223D0001XDental ProvidersDentistDental Public Health