=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023912748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERITAGE DENTAL CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2026
-----------------------------------------------------
Last Update Date | 10/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 809 LINCOLN HWY W
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46774-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-277-6551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 809 LINCOLN HWY W
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46774-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | LAYTH ABBOOD
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 248-277-6551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------