Provider Demographics
NPI:1417038936
Name:HEISEY, TAMMY KNAPP (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:KNAPP
Last Name:HEISEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 BROOKLEY AVE SW
Mailing Address - Street 2:579TH MDG/SGHC
Mailing Address - City:BOLLING AFB
Mailing Address - State:DC
Mailing Address - Zip Code:20032-7704
Mailing Address - Country:US
Mailing Address - Phone:202-404-3603
Mailing Address - Fax:
Practice Address - Street 1:238 BROOKLEY AVE SW
Practice Address - Street 2:579TH MDG/SGHC
Practice Address - City:BOLLING AFB
Practice Address - State:DC
Practice Address - Zip Code:20032-7704
Practice Address - Country:US
Practice Address - Phone:202-404-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029261L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice