Provider Demographics
NPI:1235228529
Name:HEISELMAN, FREDERICK A (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:A
Last Name:HEISELMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7140 MIAMI AVE
Mailing Address - Street 2:STE. 201
Mailing Address - City:MADEIRA
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2676
Mailing Address - Country:US
Mailing Address - Phone:513-561-8600
Mailing Address - Fax:513-561-8602
Practice Address - Street 1:7140 MIAMI AVE
Practice Address - Street 2:STE. 201
Practice Address - City:MADEIRA
Practice Address - State:OH
Practice Address - Zip Code:45243-2676
Practice Address - Country:US
Practice Address - Phone:513-561-8600
Practice Address - Fax:513-561-8602
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH184051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice