Healthcare Provider Details

I. General information

NPI: 1023912748
Provider Name (Legal Business Name): HERITAGE DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 LINCOLN HWY W
NEW HAVEN IN
46774-2139
US

IV. Provider business mailing address

809 LINCOLN HWY W
NEW HAVEN IN
46774-2139
US

V. Phone/Fax

Practice location:
  • Phone: 248-277-6551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAYTH ABBOOD
Title or Position: DENTIST
Credential: DDS
Phone: 248-277-6551