Healthcare Provider Details

I. General information

NPI: 1841505245
Provider Name (Legal Business Name): ANNALISA MARIE HECK D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 S IH 35 SUITE 1-D
AUSTIN TX
78744-4824
US

IV. Provider business mailing address

6801 S IH 35 SUITE 1-D
AUSTIN TX
78744-4824
US

V. Phone/Fax

Practice location:
  • Phone: 512-608-4420
  • Fax: 512-608-4424
Mailing address:
  • Phone: 512-608-4420
  • Fax: 512-608-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25832
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: