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General NPI Number Information
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NPI Number | 1770591851
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Entity Type | Individual
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Provider Name | NICHOLAS RYAN HEIN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 1200 E WOODHURST DR SUITE H100
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4261
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Country | US
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Telephone | 303-918-9080
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14622
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City | SPRINGFIELD
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State | MO
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Zip | 65814-0622
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Country | US
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Telephone | 303-918-9080
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Fax |
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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 | 9204
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2008029194
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License Number State | MO
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