MEDICARE: DR. NATHANIEL HEIMANN 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	122300000X	Dentist	8024	NE

General Provider Information

NPI Number	:	1710721881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHANIEL HEIMANN DDS

Provider Business Mailing Address
First Line	:	18915 ANNE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-3577
Country	:	US
Telephone Number	:	402-881-6629
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 E MILITARY AVE
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-5463
Country	:	US
Telephone Number	:	402-721-8770
Fax Number	:

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

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/24/2024

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