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General NPI Number Information
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NPI Number | 1245457571
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Entity Type | Organization
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Legal Business Name | KYLE W HEINE DMD PC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 44 JON ST
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City | METROPOLIS
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State | IL
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Zip | 62960-2474
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Country | US
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Telephone | 618-524-7303
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Fax |
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Provider Business Mailing Address
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Address Line | 44 JON ST
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City | METROPOLIS
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State | IL
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Zip | 62960-2474
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KYLE HEINE
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Credential |
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Telephone | 618-524-7303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State | IL
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