Provider Demographics
NPI:1942331137
Name:ORAL IMPLANTS AND RECONSTRUCTIVE DENTISTRY
Entity Type:Organization
Organization Name:ORAL IMPLANTS AND RECONSTRUCTIVE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-885-1215
Mailing Address - Street 1:145 GREEN MEADOWS DR S
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9458
Mailing Address - Country:US
Mailing Address - Phone:614-885-1215
Mailing Address - Fax:
Practice Address - Street 1:145 GREEN MEADOWS DRIVE SOUTH
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035
Practice Address - Country:US
Practice Address - Phone:614-885-1215
Practice Address - Fax:614-885-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189051223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty