Provider Demographics
NPI:1396784427
Name:HEITMAN, KENNETH LLOYD (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LLOYD
Last Name:HEITMAN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6278
Mailing Address - Country:US
Mailing Address - Phone:317-882-5088
Mailing Address - Fax:317-889-4734
Practice Address - Street 1:8101 SHELBY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6278
Practice Address - Country:US
Practice Address - Phone:317-882-5088
Practice Address - Fax:317-889-4734
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120080561223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics