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General NPI Number Information
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NPI Number | 1386751592
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Entity Type | Individual
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Provider Name | HEATHER MARIE KALLIES DDS
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Gender | Female
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 245 E 8TH ST
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-3427
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Country | US
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Telephone | 740-775-0808
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Fax |
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Provider Business Mailing Address
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Address Line | 7560 BRUNS CT
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City | CANAL WINCHESTER
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State | OH
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Zip | 43110-8747
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Country | US
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Telephone | 614-833-0260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 21634
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License Number State | OH
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