Provider Demographics
NPI:1598518599
Name:CLEARY, HEATHER (DDS)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CLEARY
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 1:4638 SEPULVEDA BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2726
Mailing Address - Country:US
Mailing Address - Phone:952-486-1074
Mailing Address - Fax:
Practice Address - Street 1:806 NEW LOS ANGELES AVE STE B
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3609
Practice Address - Country:US
Practice Address - Phone:805-529-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS110145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist