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General NPI Number Information
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NPI Number | 1508710401
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Entity Type | Organization
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Legal Business Name | HEARTLAND PERIODONTAL & DENTAL IMPLANT CENTER, LLC
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Dates
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Enumeration Date | 02/26/2026
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Last Update Date | 02/26/2026
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Provider Practice Location Address
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Address Line | 5850 BOYMEL DR STE 2
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City | FAIRFIELD
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State | OH
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Zip | 45014-5500
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Country | US
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Telephone | 513-856-8252
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Fax | 513-805-7086
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Provider Business Mailing Address
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Address Line | 5850 BOYMEL DR STE 2
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City | FAIRFIELD
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State | OH
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Zip | 45014-5500
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Country | US
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Telephone | 513-856-8252
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Fax | 513-805-7086
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Authorized Official
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Title or Position | PERIODONTIST/DENTIST
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Name | MOSTAFA TABAA
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Credential | DDS
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Telephone | 513-856-8252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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