Healthcare Provider Details

I. General information

NPI: 1730473133
Provider Name (Legal Business Name): HEATHER H HRADEK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CUMBERLAND XING
VALPARAISO IN
46383-2356
US

IV. Provider business mailing address

1105 CUMBERLAND XING
VALPARAISO IN
46383-2356
US

V. Phone/Fax

Practice location:
  • Phone: 219-256-5615
  • Fax:
Mailing address:
  • Phone: 219-256-9561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12011617A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: