Individual
JONAH SEAN HEITMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1491 E 10TH ST, ROLLA, MO 65401-3996
(573) 364-2868
Mailing address
1704 PALMER CT, ROLLA, MO 65401-8336
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2022018757
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2022018757
MO DENTAL BOARD LICENSE NUMBER
MO
Enumeration date
06/03/2022
Last updated
06/03/2022
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