# HERITAGE FAMILY DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154693752
- **Authorized official:** NISSA MCCONNELL (OWNER/DENTIST)
- **Authorized official phone:** (812) 476-3002

## Contact information

- **Practice address:** 731 N GREEN RIVER RD, EVANSVILLE, IN 47715-2415
- **Practice address phone:** (812) 476-3002
- **Practice address fax:** (812) 476-3027
- **Mailing address:** 731 N GREEN RIVER RD, EVANSVILLE, IN 47715-2415
- **Mailing address phone:** (812) 476-3002
- **Mailing address fax:** (812) 476-3027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12011723A | IN | Yes |

## Other

- **Enumeration date:** 01/30/2012
- **Last updated:** 01/30/2012