Provider Demographics
NPI:1164406443
Name:HEIL, EDGAR ADAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:ADAM
Last Name:HEIL
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 1:514 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-5321
Mailing Address - Country:US
Mailing Address - Phone:860-889-5166
Mailing Address - Fax:860-887-8254
Practice Address - Street 1:514 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5321
Practice Address - Country:US
Practice Address - Phone:860-889-5166
Practice Address - Fax:860-887-8254
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20664122300000X
CT009806122300000X
CT98061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236354Medicaid
CT004236354Medicaid