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General NPI Number Information
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NPI Number | 1962881748
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Entity Type | Organization
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Legal Business Name | LEGACY DENTAL OF GLEN OAKS
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 4767 VISTA WOOD BLVD STE 110
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City | DALLAS
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State | TX
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Zip | 75232
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Country | US
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Telephone | 214-321-8383
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Fax |
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Provider Business Mailing Address
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Address Line | 4767 VISTA WOOD BLVD STE 110
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City | DALLAS
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State | TX
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Zip | 75232
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL GERALD HEFFELFINGER
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Credential | DDS
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Telephone | 972-563-8383
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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 | 25393
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License Number State | TX
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