Healthcare Provider Details

I. General information

NPI: 1801917810
Provider Name (Legal Business Name): SARAH B. HEUER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S WEBSTER AVE SUITE 402
GREEN BAY WI
54301-3528
US

IV. Provider business mailing address

704 S. WEBSTER AVENUE SUITE 402
GREEN BAY WI
54301
US

V. Phone/Fax

Practice location:
  • Phone: 920-435-6894
  • Fax:
Mailing address:
  • Phone: 920-435-6894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4684
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: