MEDICARE: DR. KURT CHARLES HEUERMAN DDS

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	14179	MI

General Provider Information

NPI Number	:	1699875302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KURT CHARLES HEUERMAN DDS

Provider Business Mailing Address
First Line	:	4450 W WALTON BLVD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48329-4093
Country	:	US
Telephone Number	:	248-674-0495
Fax Number	:	248-674-4308

Provider Business Practice Location Address
First Line	:	4450 W WALTON BLVD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48329-4093
Country	:	US
Telephone Number	:	248-674-0495
Fax Number	:	248-674-4308

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

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	07/08/2007

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