MEDICARE: MAGGIE HEIMAN 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	2018021726	MO

General Provider Information

NPI Number	:	1811482326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGGIE HEIMAN DDS

Provider Business Mailing Address
First Line	:	1800 COMMUNITY
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-8804
Country	:	US
Telephone Number	:	660-885-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 N GAINES DR
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-1132
Country	:	US
Telephone Number	:	888-403-1071
Fax Number	:

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

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	05/17/2019

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