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General NPI Number Information
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NPI Number | 1932246733
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Entity Type | Organization
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Legal Business Name | HEIM & CARROLL DMD LLC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 36 WELLES ST SUITE 240
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City | GLASTONBURY
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State | CT
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Zip | 06033-2080
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Country | US
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Telephone | 860-633-2031
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Fax |
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Provider Business Mailing Address
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Address Line | 36 WELLES ST SUITE 240
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City | GLASTONBURY
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State | CT
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Zip | 06033-2080
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Country | US
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Telephone | 860-633-2031
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. BRAD A HEIM
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Credential | DMD
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Telephone | 860-633-2031
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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 | 8882
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6781
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License Number State | CT
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