Healthcare Provider Details

I. General information

NPI: 1841376852
Provider Name (Legal Business Name): MIKE W HECOX D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E STREET
COZAD NE
69130-1845
US

IV. Provider business mailing address

810 E STREET PO BOX 287
COZAD NE
69130-1845
US

V. Phone/Fax

Practice location:
  • Phone: 308-784-2828
  • Fax: 308-784-2834
Mailing address:
  • Phone: 308-784-2828
  • Fax: 308-784-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5129
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: