MEDICARE: DR. DAVID MAX HEYDENREICH D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2174	VT

General Provider Information

NPI Number	:	1477618635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MAX HEYDENREICH D.M.D.

Provider Business Mailing Address
First Line	:	192 ROCKINGHAM ST
Second Line	:
City	:	BELLOWS FALLS
State	:	VT
Zip	:	05101-1349
Country	:	US
Telephone Number	:	802-463-3187
Fax Number	:	802-463-4021

Provider Business Practice Location Address
First Line	:	192 ROCKINGHAM ST
Second Line	:
City	:	BELLOWS FALLS
State	:	VT
Zip	:	05101-1349
Country	:	US
Telephone Number	:	802-463-3187
Fax Number	:	802-463-4021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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