Provider Demographics
NPI:1285015537
Name:HEISSER, ERIC LENDBURGH (DDS, FAGD, FICOI)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LENDBURGH
Last Name:HEISSER
Suffix:
Gender:M
Credentials:DDS, FAGD, FICOI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3933 DEGRAVES CT
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-4382
Mailing Address - Country:US
Mailing Address - Phone:231-670-2851
Mailing Address - Fax:
Practice Address - Street 1:340 SEMINOLE RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3733
Practice Address - Country:US
Practice Address - Phone:231-670-2851
Practice Address - Fax:231-739-5309
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010215361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1285015537OtherNPI