Healthcare Provider Details

I. General information

NPI: 1306949680
Provider Name (Legal Business Name): THOMAS A HEYDINGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 WESTERN AVENUE
W BRATTLEBORO VT
05303
US

IV. Provider business mailing address

PO BOX 2350
BRATTLEBORO VT
05303-2350
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-2384
  • Fax: 802-254-5717
Mailing address:
  • Phone: 802-254-2384
  • Fax: 802-254-5717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0856
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: