Healthcare Provider Details

I. General information

NPI: 1174870547
Provider Name (Legal Business Name): JEFFREY DAVID HEYSE JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2012
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 CENTRAL PARK BLVD UNIT 203
DENVER CO
80238-2300
US

IV. Provider business mailing address

1638 POPLAR ST
DENVER CO
80220-1837
US

V. Phone/Fax

Practice location:
  • Phone: 720-594-1024
  • Fax:
Mailing address:
  • Phone: 702-336-8569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number00204233
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number28212
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: