MEDICARE: DR. MICHAEL G HEFFELFINGER D.D.S.

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	25393	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295055739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL G HEFFELFINGER D.D.S.

Provider Business Mailing Address
First Line	:	1700 CEDAR SPRINGS RD
Second Line	:	#2507
City	:	DALLAS
State	:	TX
Zip	:	75202-1203
Country	:	US
Telephone Number	:	610-509-8992
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 W MOORE AVE
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-2303
Country	:	US
Telephone Number	:	972-563-8383
Fax Number	:	972-563-8384

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	03/01/2013

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