Healthcare Provider Details

I. General information

NPI: 1952522591
Provider Name (Legal Business Name): HEATHER MICHELLE ADISKA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WEST MAIN
STOCKBRIDGE MI
49285
US

IV. Provider business mailing address

2876 BROGAN RD
STOCKBRIDGE MI
49285-9617
US

V. Phone/Fax

Practice location:
  • Phone: 517-851-8008
  • Fax: 517-851-8836
Mailing address:
  • Phone: 734-777-9091
  • Fax: 517-851-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901019123
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: