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General NPI Number Information
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NPI Number | 1619356631
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Entity Type | Organization
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Legal Business Name | HEATHER DESH ORTHODONTICS, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 4714 E LOS COYOTES DIAGONAL
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City | LONG BEACH
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State | CA
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Zip | 90815-2825
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Country | US
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Telephone | 562-283-6590
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Fax |
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Provider Business Mailing Address
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Address Line | 354 LOMA AVE
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City | LONG BEACH
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State | CA
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Zip | 90814-2745
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Country | US
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Telephone | 610-762-0997
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HEATHER DESH
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Credential | D.M.D.
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Telephone | 610-762-0997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 61640
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License Number State | CA
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