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General NPI Number Information
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NPI Number | 1366346173
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Entity Type | Organization
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Legal Business Name | HERITAGE ORAL SURGERY AND IMPLANT CENTERS
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 22142 SHERMAN WAY STE 201
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City | CANOGA PARK
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State | CA
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Zip | 91303-1136
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Country | US
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Telephone | 818-703-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 22142 SHERMAN WAY STE 201
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City | CANOGA PARK
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State | CA
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Zip | 91303-1136
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Country | US
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Telephone | 818-703-8200
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Fax |
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Authorized Official
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Title or Position | VP, PAYOR RELATIONS
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Name | MICHAELA MUNIZ
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Credential |
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Telephone | 469-324-3242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State | NULL
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