1376654905 NPI number — DR. ROBERT HEIST DDS

Table of content: DR. ROBERT HEIST DDS (NPI 1376654905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376654905 NPI number — DR. ROBERT HEIST DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIST
Provider First Name:
ROBERT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376654905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2051 KAEN RD
Provider Second Line Business Mailing Address:
367
Provider Business Mailing Address City Name:
OREGON CITY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97045-4035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-650-3110
Provider Business Mailing Address Fax Number:
503-742-5979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9775 SE SUNNYSIDE RD
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015-5739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-655-8471
Provider Business Practice Location Address Fax Number:
503-723-4907
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  30015652 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: D8746 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D8746 . This is a "STATE LICENCE NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 099071 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: R103163 . This is a "MEDICARE PART B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 168395 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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