MEDICARE: DR. MICHAEL THOMAS HEILAND DDS

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	14724	MO

General Provider Information

NPI Number	:	1568564516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL THOMAS HEILAND DDS

Provider Business Mailing Address
First Line	:	PO BOX 326
Second Line	:
City	:	COTTLEVILLE
State	:	MO
Zip	:	63338-0326
Country	:	US
Telephone Number	:	314-616-4201
Fax Number	:

Provider Business Practice Location Address
First Line	:	5650 MEXICO RD STE 5
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1696
Country	:	US
Telephone Number	:	636-447-6665
Fax Number	:	636-447-2973

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	04/08/2021

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