Provider Demographics
NPI:1689724312
Name:HEUER, KARL V (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:V
Last Name:HEUER
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 1:313 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-1602
Mailing Address - Country:US
Mailing Address - Phone:585-589-4325
Mailing Address - Fax:
Practice Address - Street 1:313 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1602
Practice Address - Country:US
Practice Address - Phone:585-589-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031653122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00467914Medicaid
NY70660KHOtherEXCELLUS