Active NPI
Jonah Sean Heitman, DDS
- Dentist
- Rolla, MO
National Provider Identifier
1225777485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2022018757
- Practice address
- 1491 E 10TH St
Rolla, MO 65401-3996 - Phone
- (573) 364-2868
- NPI assigned
- Jun 3, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2022018757 | MO | Primary |
Addresses
Primary practice location
1491 E 10TH St
Rolla, MO 65401-3996
Mailing address
1704 Palmer CT
Rolla, MO 65401-8336
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2022018757 | Other | MO | MO DENTAL BOARD LICENSE NUMBER |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | BlueNote | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2022018757 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heitman Family Dentistry LLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654214400000",
"number": "1225777485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1704 PALMER CT",
"city": "ROLLA",
"state": "MO",
"postal_code": "654018336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1491 E 10TH ST",
"city": "ROLLA",
"state": "MO",
"postal_code": "654013996",
"telephone_number": "573-364-2868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEITMAN",
"first_name": "JONAH",
"middle_name": "SEAN",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-03",
"last_updated": "2022-06-03",
"certification_date": "2022-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2022018757",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MO DENTAL BOARD LICENSE NUMBER",
"identifier": "2022018757",
"state": "MO"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "BlueNote",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1491 E 10th St",
"city": "Rolla",
"state": "MO",
"country_code": "US",
"postal_code": "654013996",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.