MEDICARE: DR. TAMMY KNAPP HEISEY DMD

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	1223G0001X	General Practice Dentistry	DS029261L	PA

General Provider Information

NPI Number	:	1417038936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMMY KNAPP HEISEY DMD

Provider Business Mailing Address
First Line	:	238 BROOKLEY AVE SW
Second Line	:	579TH MDG/SGHC
City	:	BOLLING AFB
State	:	DC
Zip	:	20032-7704
Country	:	US
Telephone Number	:	202-404-3603
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 BROOKLEY AVE SW
Second Line	:	579TH MDG/SGHC
City	:	BOLLING AFB
State	:	DC
Zip	:	20032-7704
Country	:	US
Telephone Number	:	202-404-3603
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	06/10/2013

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