Heritage Dental Group USA.LLC

Primary specialty

DentistTaxonomy code 122300000X

License

4049 Issued in AL

Legal business name

HERITAGE DENTAL GROUP USA.LLC

Practice address

740 Hillcrest Rd Ste 2B
Mobile, AL 36695-4021

Phone

(251) 639-0911

Fax

(251) 633-7889

NPI assigned

Jan 12, 2016

Last updated

Jan 12, 2016By 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

Ms. Shyrl L Johnson

Title

Office Manager

Phone

(251) 639-0911

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Heritage Dental Group USA LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Heritage Dental Group USA, LLC

  • General Practice Dentistry
  • High Point, NC
  • NPI 1487072815
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samuel L. Johnson, DDS

  • General Practice Dentistry
  • Mobile, AL
  • NPI 1417006677
  NPD (past)
• Shauna L. Palmer, DDS

  • General Practice Dentistry
  • Mobile, AL
  • NPI 1750430591
  NPD (past)

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

{
    "created_epoch": "1452556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452556800000",
    "number": "1801252473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 HILLCREST RD STE 2B",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366954021",
            "telephone_number": "251-639-0911",
            "fax_number": "251-633-7889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 HILLCREST RD STE 2B",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366954021",
            "telephone_number": "251-639-0911",
            "fax_number": "251-633-7889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE DENTAL GROUP USA.LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-12",
        "last_updated": "2016-01-12",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SHYRL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "251-639-0911",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AL",
            "license": "4049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165097",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Milligan Hensley
• Matthew Henson
• William Randal Duncan Henson, DO
• Dana Maria Herazo, RD,LD,CDE
• Andrea N. Herbert, PT
• Heritage Pharmacy, Inc.
• Heritage Woods Operations, LLC (Elmcroft of Heritage Woods)
• Gina Hermon
• Amber Nicole Hernandez-Sexton
• Katherine Anne Hernandez, M.S.

• Dentist in Mobile, AL
• Providers in Mobile, AL by specialty
• Dentist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; 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.