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General NPI Number Information
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NPI Number | 1780781658
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Entity Type | Individual
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Provider Name | DAVID RAYMOND HEIDELBERG DDS
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 30 EXECUTIVE DR
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City | NORWALK
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State | OH
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Zip | 44857-2480
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Country | US
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Telephone | 419-668-6589
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Fax | 419-663-4601
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Provider Business Mailing Address
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Address Line | 4 VICTORIA CIR
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City | NORWALK
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State | OH
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Zip | 44857-1656
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Country | US
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Telephone | 419-663-7515
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17794
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License Number State | OH
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