Leslie James Heinemann, DDS
Individual provider Active NPI General Practice Dentistry · Flandreau, SD
NPI 1629136502 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1629136502
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- M-584 (SD)
- Practice address
- 406 W Pipestone Ave
Flandreau, SD 57028-1617 - Phone
- (605) 997-3732
- Fax
- (605) 997-3799
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150603002266 | SD | Order and Referring Only - Dentist |
3375864259 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-584 | SD | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | M-584 | SD | Yes |
Addresses
Primary practice location
406 W Pipestone Ave
Flandreau, SD 57028-1617
Mailing address
406 W Pipestone Ave
Flandreau, SD 57028-1617
Phone (605) 997-3732
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 78-03480 | Medicaid | SD |
Other providers in Flandreau, SD
- Flandreau School District #50-3
- Elisabetta Giomo-James
- Greenleaf Assisted Living, Inc.
- Steven Headrick
- Heinemann & Heinemann
- Jay-Med Inc.
- Cynthia Marie Johanson
- Gina Teresa Johanson
- Oksana Johnson
- Alla Anatoly Jones
All providers in Flandreau, SD · General Practice Dentistry in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.