Provider Demographics
NPI:1679797641
Name:MAUPIN, HEATHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:MAUPIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 W MAIN ST
Mailing Address - Street 2:SUITE 151
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-9700
Mailing Address - Country:US
Mailing Address - Phone:317-838-7100
Mailing Address - Fax:317-885-0417
Practice Address - Street 1:1070 W MAIN ST
Practice Address - Street 2:SUITE 151
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-9700
Practice Address - Country:US
Practice Address - Phone:317-838-7100
Practice Address - Fax:317-885-0417
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010749A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN271Medicaid