Provider Demographics
NPI:1962572529
Name:HERITAGE DENTAL ASSOCIATES
Entity type:Organization
Organization Name:HERITAGE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:NIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-525-1415
Mailing Address - Street 1:1747 HERITAGE LN
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-8552
Mailing Address - Country:US
Mailing Address - Phone:801-525-1415
Mailing Address - Fax:801-525-0583
Practice Address - Street 1:1747 HERITAGE LN
Practice Address - Street 2:SUITE A-1
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-8552
Practice Address - Country:US
Practice Address - Phone:801-525-1415
Practice Address - Fax:801-525-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty