Provider Demographics
NPI:1679592612
Name:HEITZMANN, SCOTT JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JOSEPH
Last Name:HEITZMANN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:725 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-1757
Mailing Address - Country:US
Mailing Address - Phone:850-271-8001
Mailing Address - Fax:850-277-0390
Practice Address - Street 1:725 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-1757
Practice Address - Country:US
Practice Address - Phone:850-271-8001
Practice Address - Fax:850-277-0390
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17426204E00000X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery