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General NPI Number Information
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NPI Number | 1407372279
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Entity Type | Organization
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Legal Business Name | SUSAN MCADAMS HEINZEN DDS, P.A.
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 08/14/2017
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Provider Practice Location Address
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Address Line | 150 S TULSA AVE
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-4600
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Country | US
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Telephone | 479-968-2100
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Fax | 479-968-2107
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Provider Business Mailing Address
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Address Line | 150 S TULSA AVE
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-4600
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Country | US
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Telephone | 479-968-2100
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Fax | 479-968-2107
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. SUSAN MCADAMS HEINZEN
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Credential | DDS
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Telephone | 479-968-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4149
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License Number State | AR
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