Healthcare Provider Details

I. General information

NPI: 1780790329
Provider Name (Legal Business Name): ROBERT W. HEYDRICH D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 SPRING HILL DR
SPRING HILL FL
34606-4558
US

IV. Provider business mailing address

5305 SPRING HILL DR
SPRING HILL FL
34606-4558
US

V. Phone/Fax

Practice location:
  • Phone: 352-688-7858
  • Fax: 352-688-7816
Mailing address:
  • Phone: 352-688-7858
  • Fax: 352-688-7816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN 15565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: