Healthcare Provider Details

I. General information

NPI: 1720133812
Provider Name (Legal Business Name): HEYO H TJARKS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 JOHN F KENNEDY RD
DUBUQUE IA
52002
US

IV. Provider business mailing address

1890 JOHN F KENNEDY RD
DUBUQUE IA
52002
US

V. Phone/Fax

Practice location:
  • Phone: 563-556-4234
  • Fax: 563-556-0597
Mailing address:
  • Phone: 563-556-4234
  • Fax: 563-556-0597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number05476
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: