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General NPI Number Information
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NPI Number | 1457774184
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Entity Type | Individual
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Provider Name | NATALIE RUTH HEAIVILIN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/31/2014
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 1011 N UNIVERSITY AVE
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City | ANN ARBOR
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State | MI
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Zip | 48109-1078
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Country | US
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Telephone | 734-936-5950
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Fax |
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Provider Business Mailing Address
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Address Line | 3515 LARCHMONT DR
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City | ANN ARBOR
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State | MI
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Zip | 48105-2853
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Country | US
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Telephone | 913-593-5842
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401416320
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 63326
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901601122
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License Number State | MI
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