Provider Demographics
NPI:1437302635
Name:HEARTLAND DENTAL CARE OF OH, RICHARD E. WORKMAN, DMD PS
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF OH, RICHARD E. WORKMAN, DMD PS
Other - Org Name:LIBERTY COMMONS FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:6862 LIBERTY PLAZA
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9138
Mailing Address - Country:US
Mailing Address - Phone:217-540-5100
Mailing Address - Fax:
Practice Address - Street 1:6862 LIBERTY PLAZA
Practice Address - Street 2:SUITE 500
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9138
Practice Address - Country:US
Practice Address - Phone:217-540-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF OH, RICHARD E. WORKMAN, DMD PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty