HERITAGE DENTAL LLC (NPI# 1154574846) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154574846 |
| Entity Type | Organization |
| Organization Name | HERITAGE DENTAL LLC |
| Other Organization Name | JAMES M MAIXNER DDS |
| Practice Address |
1400 10th Ave Sw Waverly IA 50677-3752 |
| Mailing Address |
1400 10th Ave Sw P.o. Box 854 Waverly IA 50677-3752 |
| Practice Telephone | 3193525222 |
| Practice Fax Number | 3193525225 |
| Mailing Telephone | 3193525222 |
| Mailing Fax Number | 3193525225 |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2009-07-06 |
| Authorized Official Name | JAMES MICHAEL MAIXNER (MANAGER) |
| Authorized Official Telephone | 3193525222 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
06793 | IA | Dental Providers |
| Other Name | Type Code |
|---|---|
| James M Maixner DDS | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467982728 | Heritage Dental LLC | Clinic/Center | 9598 Palmetto Commerce Parkway, Ladson, SC 29456 | 2017-06-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | HERITAGE DENTAL LLC | 1400 10th Ave Sw, P.o. Box 854, Waverly, IA 50677 |
| Street Address |
1400 10TH AVE SW |
| City | WAVERLY |
| State | IA |
| Zip Code | 50677-3752 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154952166 | Purvi Vaghela | Dentist | 1400 10th Ave Sw, Waverly, IA 50677-3752 | 2020-01-29 |
| 1831684745 | Matthew A Mueller | Dentist | 1400 10th Ave Sw, Waverly, IA 50677-3752 | 2018-06-25 |
| 1184152050 | Jordan Henry Otto | Dentist | 1400 10th Ave Sw, Waverly, IA 50677-3752 | 2017-05-23 |
| 1831645548 | Bryan Michael Horak | Dentist | 1400 10th Ave Sw, Waverly, IA 50677-3752 | 2016-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225514540 | North Iowa Counseling, LLC | Community/Behavioral Health | 506 E Bremer Ave, Waverly, IA 50677 | 2018-07-19 |
| 1942707211 | Eastern Iowa Therapeutics P.C. | Occupational Therapist | 155 Cedar River Parkway, Suite 101, Waverly, IA 50677 | 2018-04-12 |
| 1255887170 | Amy Susan Roling | Counselor | 118 1 Street Sw, Waverly, IA 50677 | 2016-08-31 |
| 1770995581 | Pauline Beth Meyer | Chiropractor | 307 Crestwood Ave, Waverly, IA 50677 | 2014-05-28 |
| 1043652860 | Jan Paula Davis | Nurse Practitioner | 312 9th St Sw Ste 3300, Waverly, IA 50677 | 2013-07-22 |
| 1134425648 | Jerry P Mahacek | Dentist | 601 Brown Lane, Waverly, IA 50677 | 2011-01-31 |
| 1851619811 | Phillip Nathaniel Fitch | Optometrist | 1300 10th Ave Sw, Waverly, IA 50677 | 2010-05-13 |
| 1801008545 | Leasa Marie Lantzky | Occupational Therapist | 315 3rd Ave. N.e., Waverly, IA 50677 | 2007-05-04 |
| 1891860490 | Joel M Walsworth | Dentist | 121 20th St Nw, Waverly, IA 50677 | 2006-11-21 |
| 1205900602 | Cynthia Sue Peters | Social Worker | 825 1st Ave Ne, Waverly, IA 50677 | 2006-11-17 |
| Find all providers in zip 50677 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134425648 | Jerry P Mahacek | Dentist | 601 Brown Lane, Waverly, IA 50677 | 2011-01-31 |
| 1740424027 | Apollo Dental Consulting, P.C. | Dentist | 13220 Callum Dr Ste 5, Waverly, NE 68462-2560 | 2009-04-30 |
| 1043410046 | Alison Elizabeth Slechter | Dentist | 513 East Emmitt Ave, Waverly, OH 45690 | 2007-07-19 |
| 1760693162 | David Lynn Martin | Dentist | 106 Caudill Rd, Waverly, OH 45690-1001 | 2007-05-25 |
| 1881726560 | Timothy J Vacek | Dentist | 13220 Callum Dr # 5, Waverly, NE 68462-2560 | 2007-03-09 |
| 1063577088 | Aldan J Lori | Dentist | 531 Clinton St, Waverly, PA 18471-7703 | 2006-12-27 |
| 1952474322 | Dean Howard Sheller | Dentist | 201 20th St Nw, Waverly, IA 50677-2017 | 2006-11-15 |
| 1790791895 | Paul Michael Kelley | Dentist | 48 Overlook Dr, Waverly, OH 45690-9042 | 2006-07-31 |
| 1104845007 | Samuel Collin Orme | Dentist | 284 State Route 17c, Waverly, NY 14892-9507 | 2006-07-19 |
| 1528083839 | Alan P Young | Dentist | 1404 3rd St. Sw, Waverly, IA 50677 | 2006-07-13 |
| Find all providers in WAVERLY | ||||
Please comment or provide details below to improve the information on HERITAGE DENTAL LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.