Provider Demographics
NPI:1306488838
Name:I HEART DENTAL LLC
Entity type:Organization
Organization Name:I HEART DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:DEALE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-499-1133
Mailing Address - Street 1:135 GOSHEN ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5546
Mailing Address - Country:US
Mailing Address - Phone:912-499-1133
Mailing Address - Fax:912-348-5806
Practice Address - Street 1:135 GOSHEN ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5546
Practice Address - Country:US
Practice Address - Phone:912-499-1133
Practice Address - Fax:912-348-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty