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General NPI Number Information
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NPI Number | 1467763730
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Entity Type | Individual
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Provider Name | HEATHER LYNN SHICK D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 5472 REIMER DR
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City | ROSCOE
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State | IL
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Zip | 61073-9228
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Country | US
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Telephone | 815-623-2193
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 S MULFORD RD
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City | ROCKFORD
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State | IL
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Zip | 61108-4213
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Country | US
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Telephone | 815-623-2193
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.028339
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License Number State | IL
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