Provider Demographics
NPI:1740382811
Name:HEISS, WILLIAM CHARLES (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHARLES
Last Name:HEISS
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 1:1050 W HAYWARD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-6329
Mailing Address - Country:US
Mailing Address - Phone:417-466-7184
Mailing Address - Fax:417-466-4081
Practice Address - Street 1:1050 W HAYWARD DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-6329
Practice Address - Country:US
Practice Address - Phone:417-466-7184
Practice Address - Fax:417-466-4081
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO130731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice