Healthcare Provider Details

I. General information

NPI: 1699865998
Provider Name (Legal Business Name): JANE L. HEYDE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2006
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 E. 225 S.
WARSAW IN
46580-6213
US

IV. Provider business mailing address

2212 E. 225 S.
WARSAW IN
46580-6213
US

V. Phone/Fax

Practice location:
  • Phone: 574-269-2825
  • Fax:
Mailing address:
  • Phone: 574-269-2825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12008395
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12008395A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: