Healthcare Provider Details

I. General information

NPI: 1407059975
Provider Name (Legal Business Name): MARKUS P. HEYDER, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704B N CROATAN HWY
KITTY HAWK NC
27949-9208
US

IV. Provider business mailing address

3704B N CROATAN HWY
KITTY HAWK NC
27949-9208
US

V. Phone/Fax

Practice location:
  • Phone: 252-261-7700
  • Fax: 252-261-1770
Mailing address:
  • Phone: 252-261-7700
  • Fax: 252-261-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7863
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7775
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7863
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7775
License Number StateNC

VIII. Authorized Official

Name: MARKUS P HEYDER
Title or Position: PRESIDENT/DENTIST
Credential: D.D.S.
Phone: 252-261-7700