Organization
ACKEILIA HEATRICE DDS PC
Active
Other names
Bloomy's Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ACKEILIA K HEATRICE DDS (OWNER)
(636) 333-9711
Entity
Organization
Contact information
Practice address
24 KIEFER CREEK ROAD, ELLISVILLE, MO 63021-6013
(636) 333-9711
(636) 218-1891
Mailing address
24 KIEFER CREEK ROAD, ELLISVILLE, MO 63021-6013
(636) 333-9711
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400092761
—
MO
Enumeration date
10/28/2024
Last updated
10/28/2024
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