Provider Demographics
NPI:1477870830
Name:MICHAEL T. HEILAND D.D.S., P.C.
Entity Type:Organization
Organization Name:MICHAEL T. HEILAND D.D.S., P.C.
Other - Org Name:DISCOVERY DENTAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HEILAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-332-3106
Mailing Address - Street 1:1000 SCHROEDER CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3558
Mailing Address - Country:US
Mailing Address - Phone:636-332-3106
Mailing Address - Fax:636-332-3140
Practice Address - Street 1:305 MID RIVERS MALL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1516
Practice Address - Country:US
Practice Address - Phone:636-970-1700
Practice Address - Fax:636-970-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO147241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty