Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 3816 | WA |
NPI | 1053435594 |
---|---|
Provider Name | Dr. Mark R Heinemann |
First Address | Silverdale, WA 98383-8131 |
Second Address | Silverdale, WA 98383-8131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |