Provider Demographics
NPI:1306831466
Name:HEBDA, THOMAS WALTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WALTER
Last Name:HEBDA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 N UNION BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4084
Mailing Address - Country:US
Mailing Address - Phone:719-590-1500
Mailing Address - Fax:719-590-9379
Practice Address - Street 1:7730 N UNION BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4084
Practice Address - Country:US
Practice Address - Phone:719-590-1500
Practice Address - Fax:719-590-9379
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1055791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04019899Medicaid
CO6956-5HEMedicare ID - Type UnspecifiedPROVIDER NUMBER
COB2415Medicare ID - Type UnspecifiedDOCTOR NUMBER
COT92996Medicare UPIN
CO04019899Medicaid