Individual provider Active NPI

Joshua Ryan Heimerdinger, DMD, FAGD

  • Dentist
  • Vero Beach, FL
National Provider Identifier
1396138673
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN2890 Issued in FL
Practice address
880 37TH PL Ste 101
Vero Beach, FL 32960-6597
Phone
(772) 569-4424
NPI assigned
Mar 11, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DR60555133 WA
Student in an Organized Health Care Education/Training Program 390200000X
Dentist 122300000X DN2890 FL Primary

Addresses

Primary practice location

880 37TH PL Ste 101
Vero Beach, FL 32960-6597

Mailing address

University of Washington Dept Oforal
1959 NE Pacific Street Box 357154
Seattle, WA 98195-0001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191021000666 CO Order and Referring Only - DentistPractitioner - Dentist 6305177585

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN2890FLMDDentist
DR60555133WAMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1426032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1396138673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF WASHINGTON DEPT OFORAL",
            "address_2": "1959 NE PACIFIC STREET BOX 357154",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981950001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 37TH PL STE 101",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329606597",
            "telephone_number": "772-569-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIMERDINGER",
        "first_name": "JOSHUA",
        "middle_name": "RYAN",
        "credential": "DMD, FAGD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-11",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DR60555133",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN2890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vero Beach, FL

Sources for this page

Verify at the official NPI Registry.