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General NPI Number Information
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NPI Number | 1942331137
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Entity Type | Organization
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Legal Business Name | ORAL IMPLANTS AND RECONSTRUCTIVE DENTISTRY
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 145 GREEN MEADOWS DRIVE SOUTH
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City | LEWIS CENTER
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State | OH
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Zip | 43035
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Country | US
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Telephone | 614-885-1215
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Fax | 614-885-9314
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Provider Business Mailing Address
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Address Line | 145 GREEN MEADOWS DR S
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City | LEWIS CENTER
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State | OH
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Zip | 43035-9458
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Country | US
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Telephone | 614-885-1215
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT LOUIS HELLER
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Credential | DDS
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Telephone | 614-885-1215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 18905
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License Number State | OH
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