Healthcare Provider Details

I. General information

NPI: 1013011485
Provider Name (Legal Business Name): JAMES M HEIT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13215 BIRCH DR SUITE 100
OMAHA NE
68164
US

IV. Provider business mailing address

201 RIDGE ST SUITE 308
COUNCIL BLUFFS IA
51503-4643
US

V. Phone/Fax

Practice location:
  • Phone: 402-390-0770
  • Fax:
Mailing address:
  • Phone: 712-328-8892
  • Fax: 712-328-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7970
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: