Provider Demographics
NPI:1013186584
Name:HEINER, BRYCE (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:HEINER
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 TELSHOR CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8245
Mailing Address - Country:US
Mailing Address - Phone:575-522-8800
Mailing Address - Fax:575-521-4448
Practice Address - Street 1:2103 TELSHOR CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8245
Practice Address - Country:US
Practice Address - Phone:985-788-5782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD30681223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery