MEDICARE: DR. THOMAS HECK

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	1223E0200X	Endodontics	2269	NV

General Provider Information

NPI Number	:	1619092400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS HECK

Provider Business Mailing Address
First Line	:	2861 MEADOW PARK AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-6997
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4408 S EASTERN AVE # 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7825
Country	:	US
Telephone Number	:	702-731-1658
Fax Number	:	702-731-5262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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