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General NPI Number Information
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NPI Number | 1609003060
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Entity Type | Individual
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Provider Name | ACKEILIA K HEATRICE DDS
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Gender | Female
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 24 KIEFER CREEK RD
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City | ELLISVILLE
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State | MO
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Zip | 63021-6013
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Country | US
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Telephone | 314-367-7848
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Fax |
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Provider Business Mailing Address
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Address Line | 24 KIEFER CREEK RD
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City | ELLISVILLE
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State | MO
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Zip | 63021-6013
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Country | US
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Telephone | 636-333-9711
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 056027-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2020013343
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License Number State | MO
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