Provider Demographics
NPI:1215772694
Name:DR. MICHAEL J HEISS DENTAL PLLC
Entity type:Organization
Organization Name:DR. MICHAEL J HEISS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:HEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-425-2857
Mailing Address - Street 1:3471 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5424
Mailing Address - Country:US
Mailing Address - Phone:516-600-0506
Mailing Address - Fax:516-600-0508
Practice Address - Street 1:3471 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5424
Practice Address - Country:US
Practice Address - Phone:516-600-0506
Practice Address - Fax:516-600-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty