MEDICARE: DR. MASAHIRO HEIMA DDS, PHD

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	1223P0221X	Pediatric Dentistry	71-0000218	OH

General Provider Information

NPI Number	:	1780767970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MASAHIRO HEIMA DDS, PHD

Provider Business Mailing Address
First Line	:	10900 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1712
Country	:	US
Telephone Number	:	216-368-1379
Fax Number	:

Provider Business Practice Location Address
First Line	:	10900 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1712
Country	:	US
Telephone Number	:	216-368-1379
Fax Number	:

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	01/25/2011

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