Individual
DR. PETER J. HEATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Contact information
Practice address
270 E DAY RD, SUITE 260, MISHAWAKA, IN 46545-3444
(574) 272-8823
(574) 277-1837
Mailing address
270 E DAY RD, SUITE 260, MISHAWAKA, IN 46545-3444
(574) 272-8823
(574) 277-1837
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2503
NH
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
9545
MD
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
12434R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01063978A
IN MEDICAL LICENSE
IN
01
—
12011044A
IN DENTAL LICENSE
IN
01
—
12434R
MEDICAL LICENSE
LA
05
—
200870900
—
IN
01
—
2503
DENTAL LICENSE (INACTIVE)
NH
01
—
9545
DENTAL LICENSE
MD
Enumeration date
08/31/2005
Last updated
09/29/2015
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