Individual
ELLIE HEYDARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
36745 AIKEN RD., RED CLIFF COMMUNITY HEALTH CENTER, BAYFIELD, WI 54814
(715) 779-3707
(715) 779-3622
Mailing address
36745 AIKEN RD, 36745 AIKEN RD., BAYFIELD, WI 54814-4579
(715) 779-3707
(715) 779-3622
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
2901017468
MI
1223G0001X
General Practice Dentistry
Primary
7252-15
WI
Other
Enumeration date
03/05/2008
Last updated
02/10/2017
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