1396138673 NPI number — JOSHUA RYAN HEIMERDINGER DMD, FAGD

Table of content: JOSHUA RYAN HEIMERDINGER DMD, FAGD (NPI 1396138673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396138673 NPI number — JOSHUA RYAN HEIMERDINGER DMD, FAGD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIMERDINGER
Provider First Name:
JOSHUA
Provider Middle Name:
RYAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD, FAGD
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:
1396138673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIVERSITY OF WASHINGTON DEPT OFORAL
Provider Second Line Business Mailing Address:
1959 NE PACIFIC STREET BOX 357154
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98195-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 37TH PL STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32960-6597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-569-4424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2015

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:  DR60555133 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DN2890 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com