Provider Demographics
NPI:1366592156
Name:HEARTLAND ENDODONTICS
Entity type:Organization
Organization Name:HEARTLAND ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERMAYR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:863-382-9947
Mailing Address - Street 1:4660 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2063
Mailing Address - Country:US
Mailing Address - Phone:863-382-9947
Mailing Address - Fax:
Practice Address - Street 1:4660 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2063
Practice Address - Country:US
Practice Address - Phone:863-382-9947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0011329261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental