Provider Demographics
NPI:1538997796
Name:HERITAGE FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:HERITAGE FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PIATT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-306-0381
Mailing Address - Street 1:1631 CARROLL RD
Mailing Address - Street 2:
Mailing Address - City:MOSIER
Mailing Address - State:OR
Mailing Address - Zip Code:97040-9766
Mailing Address - Country:US
Mailing Address - Phone:541-306-0381
Mailing Address - Fax:
Practice Address - Street 1:1700 E 12TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3137
Practice Address - Country:US
Practice Address - Phone:541-298-4403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice