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NPI Code Detail

MEDICARE: DR. RICHARD KENT HEIDEMAN DMD

MEDICARE: DR. RICHARD KENT HEIDEMAN 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
1122300000XDentist6626893UT

General Provider Information

NPI Number : 1841446457
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD KENT HEIDEMAN DMD
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 : 435-688-9751
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 : 435-688-9751
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2008
Last Update Date : 08/14/2008

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