Basic Information
| Provider Information | |||||||||
| NPI: | 1144325465 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RICHARD F HEILEMANN DDS PC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1190 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER CENTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 052551190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023621099 | ||||||||
| FaxNumber: | 8023621901 | ||||||||
| Practice Location | |||||||||
| Address1: | 74 LONG VIEW DRIVE | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER CENTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023621099 | ||||||||
| FaxNumber: | 8023621901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 06/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | HEILEMANN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | FRANK | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8023621099 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DDS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 0160000600 | VT | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.