Provider Demographics
NPI:1083711394
Name:HEUCKE, RONALD WERNER (DMD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:WERNER
Last Name:HEUCKE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HORSESHOE CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-8657
Mailing Address - Country:US
Mailing Address - Phone:732-274-2999
Mailing Address - Fax:732-274-0740
Practice Address - Street 1:4105 US ROUTE ONE
Practice Address - Street 2:SUITE 15
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852
Practice Address - Country:US
Practice Address - Phone:732-274-2999
Practice Address - Fax:732-274-0740
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI015147001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice