Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2902015443 | MI |
NPI | 1013380906 |
---|---|
Provider Name | Kimberly Heuker |
First Address | Farmington Hills, MI 48331-3354 |
Second Address | Farmington Hills, MI 48331-3354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2015 |
Last Update Date | 02/11/2015 |