Provider Demographics
NPI:1699823732
Name:HEIM, BRAD A (DMD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:A
Last Name:HEIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WELLES ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2080
Mailing Address - Country:US
Mailing Address - Phone:860-633-2031
Mailing Address - Fax:
Practice Address - Street 1:36 WELLES ST
Practice Address - Street 2:SUITE 240
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2080
Practice Address - Country:US
Practice Address - Phone:860-633-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0067811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice