MEDICARE: DR. MICHAEL J HEISS DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1215772694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MICHAEL J HEISS DENTAL PLLC

Provider Business Mailing Address
First Line	:	3471 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-5424
Country	:	US
Telephone Number	:	516-600-0506
Fax Number	:	516-600-0508

Provider Business Practice Location Address
First Line	:	3471 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-5424
Country	:	US
Telephone Number	:	516-600-0506
Fax Number	:	516-600-0508

Authorized Official
Title or Position	:	DENTIST/CEO
Name	:	DR. MICHAEL JORDAN HEISS
Credential	:	DDS
Telephone Number	:	516-425-2857

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	07/11/2024

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