Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DS028299L | PA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS028299L | PA |
NPI | 1679543987 |
---|---|
Provider Name | Dr. Andrew P Heise |
First Address | Lancaster, PA 17603 |
Second Address | Lancaster, PA 17603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1730880 | (05) | PA |
32271 | BLUE SHIELD IDENTIFICATIO (01) | PA |
DS028299L | DENTAL LICENSE (01) | PA |
U68437 | (02) | PA |