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General NPI Number Information
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NPI Number | 1396738746
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Entity Type | Individual
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Provider Name | PETER J. HEATH D.D.S., M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 270 E DAY RD SUITE 260
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City | MISHAWAKA
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State | IN
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Zip | 46545-3444
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Country | US
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Telephone | 574-272-8823
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Fax | 574-277-1837
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Provider Business Mailing Address
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Address Line | 270 E DAY RD SUITE 260
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City | MISHAWAKA
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State | IN
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Zip | 46545-3444
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Country | US
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Telephone | 574-272-8823
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Fax | 574-277-1837
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 9545
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2503
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License Number State | NH
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Taxonomy #3
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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 | 12434R
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License Number State | LA
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