Provider Demographics
NPI:1235375148
Name:HEIM, VERNON MATTHEW (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:MATTHEW
Last Name:HEIM
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 MCAULEY BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8386
Mailing Address - Country:US
Mailing Address - Phone:405-755-8151
Mailing Address - Fax:405-755-8153
Practice Address - Street 1:4320 MCAULEY BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8386
Practice Address - Country:US
Practice Address - Phone:405-755-8151
Practice Address - Fax:405-755-8153
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics