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General NPI Number Information
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NPI Number | 1922104082
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Entity Type | Individual
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Provider Name | GREGORY HEIDEMAN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 6950 SMOKE RANCH RD STE 150
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City | LAS VEGAS
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State | NV
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Zip | 89128-1301
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Country | US
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Telephone | 702-304-1902
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Fax | 702-304-1909
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Provider Business Mailing Address
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Address Line | 6816 ROYAL POINCIANA CT
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City | LAS VEGAS
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State | NV
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Zip | 89131-1769
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Country | US
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Telephone | 702-677-6270
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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 | 4845
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License Number State | NV
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