Provider Demographics
NPI:1467799205
Name:RANDALL K HECKERT DMD INC
Entity Type:Organization
Organization Name:RANDALL K HECKERT DMD INC
Other - Org Name:GROWING SMILES DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:K
Authorized Official - Last Name:HECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:707-443-6781
Mailing Address - Street 1:2787 HARRIS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4873
Mailing Address - Country:US
Mailing Address - Phone:707-443-6781
Mailing Address - Fax:707-443-6719
Practice Address - Street 1:2787 HARRIS ST
Practice Address - Street 2:SUITE A
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4873
Practice Address - Country:US
Practice Address - Phone:707-443-6781
Practice Address - Fax:707-443-6719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty