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General NPI Number Information
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NPI Number | 1730597378
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Entity Type | Individual
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Provider Name | MAURINE ELIZABETH HEESCH DDS
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Gender | Female
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 1435 E 23RD ST
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City | FREMONT
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State | NE
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Zip | 68025-2433
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Country | US
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Telephone | 402-727-9100
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Fax | 402-753-9918
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Provider Business Mailing Address
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Address Line | 1435 E 23RD ST
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City | FREMONT
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State | NE
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Zip | 68025-2433
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Country | US
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Telephone | 402-727-9100
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Fax | 402-753-9918
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D1053
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7425
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License Number State | NE
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