Active NPI
Gary Michael Heidner, DDS
- General Practice Dentistry
- Garden Grove, CA
National Provider Identifier
1295999068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 23614
- Practice address
- 12752 Garden Grove Blvd
#200
Garden Grove, CA 92843-1923 - Phone
- (714) 636-2595
- Fax
- (714) 260-0177
- NPI assigned
- Jul 10, 2008
- Last updated
- Dec 27, 2012
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 23614 | CA | Primary |
Addresses
Primary practice location
12752 Garden Grove Blvd
#200
Garden Grove, CA 92843-1923
Mailing address
4248 Candleberry Ave
Seal Beach, CA 90740
Phone (562) 881-9243
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 |
|---|---|---|---|
| 23614 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356566400000",
"number": "1295999068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4248 CANDLEBERRY AVE",
"city": "SEAL BEACH",
"state": "CA",
"postal_code": "90740",
"telephone_number": "562-881-9243",
"fax_number": "714-260-0177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12752 GARDEN GROVE BLVD",
"address_2": "#200",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928431923",
"telephone_number": "714-636-2595",
"fax_number": "714-260-0177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEIDNER",
"first_name": "GARY",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-10",
"last_updated": "2012-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "23614",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
- Healthpointe Medical Group, Inc. (First Care Industrial Medicine Center)
- Healthy Smiles for Kids of Orange County
- Heart and Mind Talk Therapy
- Heather J Dale Licensed Clinical Social Worker Corporation
- Heather Heffner, DPT
- Anna Heilig-Adams, PA-C
- Helping Hands for Better Living Adult Day Health Care
- Fariba Hemat, DDS
- Kristian T Henderson
- Dwight M Hendrik, M.ED., BCBA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.