Healthcare Provider Details

I. General information

NPI: 1699875302
Provider Name (Legal Business Name): KURT CHARLES HEUERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 W WALTON BLVD
WATERFORD MI
48329-4093
US

IV. Provider business mailing address

4450 W WALTON BLVD
WATERFORD MI
48329-4093
US

V. Phone/Fax

Practice location:
  • Phone: 248-674-0495
  • Fax: 248-674-4308
Mailing address:
  • Phone: 248-674-0495
  • Fax: 248-674-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14179
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: