Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30.011012 | OH |
NPI | 1003989880 |
---|---|
Provider Name | Dr. Robert Dale Heckel |
First Address | Cleveland, OH 44106-1712 |
Second Address | Cleveland, OH 44106-1712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |