Healthcare Provider Details

I. General information

NPI: 1518371350
Provider Name (Legal Business Name): SAMANTHA HEISLER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 SCHOOL LN
HARLEYSVILLE PA
19438-1703
US

IV. Provider business mailing address

514 VESTRY DR
MAPLE GLEN PA
19002-1536
US

V. Phone/Fax

Practice location:
  • Phone: 215-513-7172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS039998
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: