Doctor Name: | HEIDI MARIE VAN GIFFEN |
NPI Number: | 1700099694 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.D. |
License Number: | DT-DO-10112253 |
Business Practice Address: | 607 Klamath Ave. Klamath Falls, OR - 97603 |
Business Phone Number: | 5418846912 |
Business Fax Number: | |
Mailing Address: | 5714 Glenrigde Way, KLAMATH FALLS |
State: | OR |
Postal Code: | 97603 |
Phone Number: | 5412738646 |
Fax Number: | |
NPI Enumeration Date: | 05/07/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 122400000X |
License Number: | DT-DO-10112253 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Denturist |
Taxonomy Specialization: | |
Taxonomy Definition: |