Provider Demographics
NPI:1376913004
Name:HEYDER & ASSOCIATES
Entity Type:Organization
Organization Name:HEYDER & ASSOCIATES
Other - Org Name:ATLANTIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARKUS
Authorized Official - Middle Name:P
Authorized Official - Last Name:HEYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-475-9841
Mailing Address - Street 1:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-1536
Mailing Address - Country:US
Mailing Address - Phone:252-474-9841
Mailing Address - Fax:
Practice Address - Street 1:503 CYPRESS LN
Practice Address - Street 2:
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954-8016
Practice Address - Country:US
Practice Address - Phone:252-474-9841
Practice Address - Fax:252-423-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902U8Medicaid