MEDICARE: TAYLOR HEINLEIN DDS PA

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1871206094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYLOR HEINLEIN DDS PA

Provider Business Mailing Address
First Line	:	5207 UNIVERSITY AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-1649
Country	:	US
Telephone Number	:	763-572-8040
Fax Number	:	763-502-2310

Provider Business Practice Location Address
First Line	:	5207 UNIVERSITY AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-1649
Country	:	US
Telephone Number	:	763-572-8040
Fax Number	:	763-502-2310

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TAYLOR HEINLEIN
Credential	:
Telephone Number	:	763-572-8040

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	01/03/2023

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