Provider Demographics
NPI:1902874464
Name:HEATER, BRUCE STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:STEVEN
Last Name:HEATER
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 1:310 W HARDIN ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-3108
Mailing Address - Country:US
Mailing Address - Phone:419-423-1499
Mailing Address - Fax:419-423-1566
Practice Address - Street 1:310 W HARDIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-3108
Practice Address - Country:US
Practice Address - Phone:419-423-1499
Practice Address - Fax:419-423-1566
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30018828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0865907Medicaid