Healthcare Provider Details

I. General information

NPI: 1235349739
Provider Name (Legal Business Name): THOMAS EUGENE HEUKE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40TH AND HOLDREGE ST.
LINCOLN NE
68583-0740
US

IV. Provider business mailing address

619 GARFIELD ST
LINCOLN NE
68502-2022
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-1470
  • Fax:
Mailing address:
  • Phone: 402-476-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4452
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: