MEDICARE: DR. WILLIAM J. HEIMANN 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
1	1223P0221X	Pediatric Dentistry	2542	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902936677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM J. HEIMANN D.D.S.

Provider Business Mailing Address
First Line	:	1526 W GLENDALE AVE STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-8576
Country	:	US
Telephone Number	:	602-864-1080
Fax Number	:	602-864-7036

Provider Business Practice Location Address
First Line	:	1526 W GLENDALE AVE STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-8576
Country	:	US
Telephone Number	:	602-864-1080
Fax Number	:	602-864-7036

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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