Heritage Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

8323 Issued in SC

Legal business name

HERITAGE DENTAL LLC

Doing business as

Heritage Dental LLC

Practice address

9598 Palmetto Commerce Parkway
Ladson, SC 29456

Phone

(860) 573-5681

NPI assigned

Jun 19, 2017

Last updated

Jun 20, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert Alan Breault, DMD

Title

President

Phone

(860) 573-5681

Specialties & licenses 1

Addresses

Other names 1

• Heritage Dental LLC Doing business as

Locations

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

{
    "created_epoch": "1497830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1467982728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9598 PALMETTO COMMERCE PARKWAY",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "29456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9598 PALMETTO COMMERCE PARKWAY",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "29456",
            "telephone_number": "860-573-5681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-19",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "BREAULT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-573-5681",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "SC",
            "license": "8323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Dental LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heritage Dental LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Haley Livingston Heaton, OTR/L
• Donasia Shakura Hendrix
• Valerie Hengemuhle, OTR/L
• Melinda Hensley, CRNA
• Elizabeth L Hercules, SLP
• Ryan Patrick Hill, DPT
• Madeleine Hodge
• Natalie Howarth Holman, DPT
• Erin Delaney Hood, OT
• Beyunka Hopkins

• Dental Clinic/Center in Ladson, SC
• Providers in Ladson, SC by specialty
• Dental Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.