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General NPI Number Information
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NPI Number | 1477870830
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Entity Type | Organization
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Legal Business Name | MICHAEL T. HEILAND D.D.S., P.C.
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 305 MID RIVERS MALL DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-1516
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Country | US
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Telephone | 636-970-1700
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Fax | 636-970-1705
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Provider Business Mailing Address
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Address Line | 1000 SCHROEDER CREEK BLVD
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City | WENTZVILLE
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State | MO
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Zip | 63385-3558
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Country | US
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Telephone | 636-332-3106
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Fax | 636-332-3140
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL THOMAS HEILAND
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Credential | DDS
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Telephone | 636-332-3106
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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 | 14724
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License Number State | MO
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