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General NPI Number Information
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NPI Number | 1750814166
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Entity Type | Organization
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Legal Business Name | HEINECKE FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 103 BELL AVE
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City | BROOKSVILLE
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State | FL
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Zip | 34601-2603
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Country | US
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Telephone | 352-796-3380
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Fax | 352-796-0937
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Provider Business Mailing Address
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Address Line | 7135 MARINER BLVD
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City | SPRING HILL
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State | FL
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Zip | 34609-1048
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Country | US
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Telephone | 352-796-0917
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Fax | 352-515-5761
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Authorized Official
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Title or Position | ASSOCIATE DENTIST
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Name | DR. ASHLEY HEINECKE MASSEY
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Credential | DMD
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Telephone | 352-796-0917
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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 | DN 22001
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License Number State | FL
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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 | DN11090
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN 22000
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License Number State | FL
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