Individual
MRS. HEATHER MICHELE WADDELOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDH
Contact information
Practice address
3118 S LAFOUNTAIN ST, KOKOMO, IN 46902-3710
(765) 864-4160
Mailing address
3118 S LAFOUNTAIN ST, KOKOMO, IN 46902-3710
(765) 864-4160
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
13004179A
IN
Other
Enumeration date
08/04/2020
Last updated
08/04/2020
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