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NPI Code Detail

MEDICARE: DR. KENT A. HEIDEMAN D.D.S.

MEDICARE: DR. KENT A. HEIDEMAN 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
11223G0001XGeneral Practice Dentistry141113UT

General Provider Information

NPI Number : 1780895219
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENT A. HEIDEMAN D.D.S.
Provider Business Mailing Address
First Line : 195 W TELEGRAPH ST
Second Line :
City : WASHINGTON
State : UT
Zip : 84780-1675
Country : US
Telephone Number : 435-673-4605
Fax Number :
Provider Business Practice Location Address
First Line : 195 W TELEGRAPH ST
Second Line :
City : WASHINGTON
State : UT
Zip : 84780-1675
Country : US
Telephone Number : 435-673-4605
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2007
Last Update Date : 07/08/2007

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