Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 63542 | CA |
NPI | 1003225145 |
---|---|
Provider Name | Dr. Jeremy Heldt |
First Address | Newport Beach, CA 92660-7720 |
Second Address | Newport Beach, CA 92660-7720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2014 |
Last Update Date | 22/02/2016 |