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General NPI Number Information
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NPI Number | 1578698718
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Entity Type | Individual
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Provider Name | PETER MARK HECKLER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11 SANTA MARIA WAY
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City | ORINDA
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State | CA
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Zip | 94563-2604
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Country | US
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Telephone | 925-254-8380
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Fax | 925-254-7160
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Provider Business Mailing Address
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Address Line | 11 SANTA MARIA WAY
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City | ORINDA
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State | CA
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Zip | 94563-2604
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Country | US
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Telephone | 925-254-8380
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Fax | 925-254-7160
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 45465
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License Number State | CA
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