Healthcare Provider Details

I. General information

NPI: 1497885032
Provider Name (Legal Business Name): THOMAS H HEFLIN DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 CARMEL AVENUE NE
ALBUQUERQUE NM
87122
US

IV. Provider business mailing address

8000 CARMEL AVENUE NE
ALBUQUERQUE NM
87122
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-0323
  • Fax: 505-884-5471
Mailing address:
  • Phone: 505-883-0323
  • Fax: 505-884-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1117
License Number StateNM

VIII. Authorized Official

Name: DR. THOMAS H HEFLIN
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 505-883-0323