Provider Demographics
NPI:1407059975
Name:MARKUS P. HEYDER, D.D.S., P.A.
Entity Type:Organization
Organization Name:MARKUS P. HEYDER, D.D.S., P.A.
Other - Org Name:ATLANTIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
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:252-261-7700
Mailing Address - Street 1:3704B N CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-9208
Mailing Address - Country:US
Mailing Address - Phone:252-261-7700
Mailing Address - Fax:252-261-1770
Practice Address - Street 1:3704B N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-9208
Practice Address - Country:US
Practice Address - Phone:252-261-7700
Practice Address - Fax:252-261-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7863122300000X, 1223G0001X
NC7775122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902569Medicaid