Provider Demographics
NPI:1033638812
Name:WCD-2, PLLC
Entity Type:Organization
Organization Name:WCD-2, PLLC
Other - Org Name:HEIM DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-779-2797
Mailing Address - Street 1:9400 STATION ST STE 175
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6821
Mailing Address - Country:US
Mailing Address - Phone:303-779-5797
Mailing Address - Fax:
Practice Address - Street 1:200 W COUNTY LINE RD STE 270
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2342
Practice Address - Country:US
Practice Address - Phone:303-791-2570
Practice Address - Fax:303-683-4198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty