Healthcare Provider Details

I. General information

NPI: 1457494163
Provider Name (Legal Business Name): KEMBER B HEINE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 N. MAIN ST.
STURGIS KY
42459
US

IV. Provider business mailing address

P.O. BOX 349
STURGIS KY
42459
US

V. Phone/Fax

Practice location:
  • Phone: 270-333-4030
  • Fax: 270-333-7998
Mailing address:
  • Phone: 270-333-4030
  • Fax: 207-333-7998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6721
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6721
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: