Healthcare Provider Details

I. General information

NPI: 1811160617
Provider Name (Legal Business Name): JERRY E. HECK, D.M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2008
Last Update Date: 04/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 W MAIN ST
MOUNT ORAB OH
45154-9452
US

IV. Provider business mailing address

470 W MAIN ST
MOUNT ORAB OH
45154-9452
US

V. Phone/Fax

Practice location:
  • Phone: 937-444-3311
  • Fax: 937-444-1720
Mailing address:
  • Phone: 937-444-3311
  • Fax: 937-444-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20458
License Number StateOH

VIII. Authorized Official

Name: DR. JERRY E HECK
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 937-444-3311