MEDICARE: BRYCE HEINER, DMD, MD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	DD3068	NM
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1386955888	OTHER		GROUP NPI

General Provider Information

NPI Number	:	1386955888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYCE HEINER, DMD, MD, LLC

Provider Business Mailing Address
First Line	:	2103 TELSHOR CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8245
Country	:	US
Telephone Number	:	575-522-8800
Fax Number	:	575-522-8800

Provider Business Practice Location Address
First Line	:	2103 TELSHOR CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8245
Country	:	US
Telephone Number	:	575-522-8800
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. BRYCE HEINER
Credential	:	DMD, MD
Telephone Number	:	575-522-8800

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	05/27/2026

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