Provider Demographics
NPI:1174618144
Name:KAUFMAN, HEATHER (DDS)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 KEW GARDENS AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2852
Mailing Address - Country:US
Mailing Address - Phone:561-799-7791
Mailing Address - Fax:561-799-7662
Practice Address - Street 1:11601 KEW GARDENS AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2852
Practice Address - Country:US
Practice Address - Phone:561-799-7791
Practice Address - Fax:561-799-7662
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice