MEDICARE: SHAWNA MAUREEN HEETLAND DDS, MSD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0025837	TX

General Provider Information

NPI Number	:	1982691234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA MAUREEN HEETLAND DDS, MSD

Provider Business Mailing Address
First Line	:	2211 MIDWESTERN PKWY STE 1
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2300
Country	:	US
Telephone Number	:	940-691-2911
Fax Number	:	940-691-4240

Provider Business Practice Location Address
First Line	:	2211 MIDWESTERN PKWY
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2300
Country	:	US
Telephone Number	:	940-691-2911
Fax Number	:	940-691-4240

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	02/12/2011

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