NPIMap

Organization Active NPI

Heritage Dental LLC

  • General Practice Dentistry
  • Waverly, IA
National Provider Identifier
1154574846
Registry record updated Jul 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
06793 Issued in IA
Legal business name
HERITAGE DENTAL LLC
Practice address
1400 10TH Ave SW
Waverly, IA 50677-3752
Phone
(319) 352-5222
Fax
(319) 352-5225
NPI assigned
Oct 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James Michael Maixner, DDSNPI 1992746762
Title
Manager
Phone
(319) 352-5222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 06793 IA Primary

Addresses

Primary practice location

1400 10TH Ave SW
Waverly, IA 50677-3752

Mailing address

1400 10TH Ave SW
P.O. Box 854
Waverly, IA 50677-3752
Phone (319) 352-5222

Other names 1

  • James M Maixner DDS Former legal business name

National Provider Directory

National Provider Directory

Locations

1400 10th Ave SW
Waverly, IA 50677
Phone (319) 352-5222

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246838400000",
    "number": "1154574846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 10TH AVE SW",
            "address_2": "P.O. BOX 854",
            "city": "WAVERLY",
            "state": "IA",
            "postal_code": "506773752",
            "telephone_number": "319-352-5222",
            "fax_number": "319-352-5225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 10TH AVE SW",
            "city": "WAVERLY",
            "state": "IA",
            "postal_code": "506773752",
            "telephone_number": "319-352-5222",
            "fax_number": "319-352-5225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2009-07-06",
        "status": "A",
        "authorized_official_last_name": "MAIXNER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "319-352-5222",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "06793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "James M Maixner DDS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Waverly, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.