Healthcare Provider Details

I. General information

NPI: 1417630500
Provider Name (Legal Business Name): HEYSE ENDODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY DAVID HEYSE JR.
Title or Position: OWNER
Credential: DMD
Phone: 720-594-1024