Provider Demographics
NPI:1861708414
Name:HEEMSTRA, PIETER H (DMD)
Entity type:Individual
Prefix:DR
First Name:PIETER
Middle Name:H
Last Name:HEEMSTRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ALEXANDER AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063
Mailing Address - Country:US
Mailing Address - Phone:724-258-8215
Mailing Address - Fax:
Practice Address - Street 1:100 ALEXANDER AVENUE
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063
Practice Address - Country:US
Practice Address - Phone:724-258-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist