MEDICARE: DR. ANNALISA MARIE HECK D.D.S.

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	1223G0001X	General Practice Dentistry	25832	TX

General Provider Information

NPI Number	:	1841505245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNALISA MARIE HECK D.D.S.

Provider Business Mailing Address
First Line	:	6801 S IH 35
Second Line	:	SUITE 1-D
City	:	AUSTIN
State	:	TX
Zip	:	78744-4824
Country	:	US
Telephone Number	:	512-608-4420
Fax Number	:	512-608-4424

Provider Business Practice Location Address
First Line	:	6801 S IH 35
Second Line	:	SUITE 1-D
City	:	AUSTIN
State	:	TX
Zip	:	78744-4824
Country	:	US
Telephone Number	:	512-608-4420
Fax Number	:	512-608-4424

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

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	09/29/2010

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