Provider Demographics
NPI:1033286315
Name:HEILMAN, LAVINDA ANN (MS)
Entity Type:Individual
Prefix:
First Name:LAVINDA
Middle Name:ANN
Last Name:HEILMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 SE 147TH AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-2500
Mailing Address - Country:US
Mailing Address - Phone:503-762-6350
Mailing Address - Fax:
Practice Address - Street 1:822 NE 181ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6708
Practice Address - Country:US
Practice Address - Phone:503-661-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA2008126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant