Healthcare Provider Details

I. General information

NPI: 1447375241
Provider Name (Legal Business Name): ENDODONTIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4408 S EASTERN AVE # 100
LAS VEGAS NV
89119-7825
US

IV. Provider business mailing address

4408 S EASTERN AVE # 100
LAS VEGAS NV
89119-7825
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-1658
  • Fax: 702-731-5262
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2269
License Number StateNV

VIII. Authorized Official

Name: DR. THOMAS HECK
Title or Position: DENTIST
Credential:
Phone: 702-731-1658