Provider Demographics
NPI:1114146206
Name:HEIN DENTAL PROFESSIONAL LLC
Entity Type:Organization
Organization Name:HEIN DENTAL PROFESSIONAL LLC
Other - Org Name:THOMAS J. HEIN DDS, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST MEMBER-MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-779-9472
Mailing Address - Street 1:8200 E BELLEVIEW AVE
Mailing Address - Street 2:SUITE 435 E
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2803
Mailing Address - Country:US
Mailing Address - Phone:303-779-9472
Mailing Address - Fax:303-779-4176
Practice Address - Street 1:8200 E BELLEVIEW AVE
Practice Address - Street 2:SUITE 435 E
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2803
Practice Address - Country:US
Practice Address - Phone:303-779-9472
Practice Address - Fax:303-779-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COH-D-1-046831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty