Provider Demographics
NPI:1508386335
Name:BRIAN W HECK, DDS PA
Entity Type:Organization
Organization Name:BRIAN W HECK, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:PAMA
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-856-0285
Mailing Address - Street 1:4621 W 6TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4358
Mailing Address - Country:US
Mailing Address - Phone:785-856-0285
Mailing Address - Fax:
Practice Address - Street 1:4621 W 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4358
Practice Address - Country:US
Practice Address - Phone:785-856-0285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental