=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750617726
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOTT S. HEYING DDS, MS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2009
-----------------------------------------------------
Last Update Date | 10/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2803 MOSSROCK STE 101
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-5131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-341-3123
-----------------------------------------------------
Fax | 210-341-3122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2803 MOSSROCK STE 101
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-5131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-341-3123
-----------------------------------------------------
Fax | 210-341-3122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SCOTT S HEYING
-----------------------------------------------------
Credential | DDS, MS
-----------------------------------------------------
Telephone | 210-341-3123
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 21412
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------