Provider Demographics
NPI:1497875553
Name:HEILMAN, PAUL COLLINS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:COLLINS
Last Name:HEILMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 FERN AVE
Mailing Address - Street 2:BLDG #1100
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5659
Mailing Address - Country:US
Mailing Address - Phone:318-797-1550
Mailing Address - Fax:318-797-1510
Practice Address - Street 1:7600 FERN AVE
Practice Address - Street 2:BLDG #1100
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5659
Practice Address - Country:US
Practice Address - Phone:318-797-1550
Practice Address - Fax:318-797-1510
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1832910Medicaid