Individual
DR. KIMBERLY LEEDS HEETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1113 PROGRESS DR, MEDFORD, OR 97504-5201
(541) 512-3900
(541) 414-1175
Mailing address
931 CHEVY WAY, MEDFORD, OR 97504-4127
(541) 535-6239
(541) 512-1029
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
21299
TX
1223P0221X
Pediatric Dentistry
Primary
D10197
OR
1223P0221X
Pediatric Dentistry
DE60088337
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1742900-01
—
TX
Enumeration date
03/09/2006
Last updated
02/25/2020
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