Provider Demographics
NPI:1598170532
Name:HECKMAN, LANDON (DMD)
Entity Type:Individual
Prefix:DR
First Name:LANDON
Middle Name:
Last Name:HECKMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3039 Q ST NW APT 34
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3096
Mailing Address - Country:US
Mailing Address - Phone:205-427-2254
Mailing Address - Fax:
Practice Address - Street 1:242 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRUSH
Practice Address - State:CO
Practice Address - Zip Code:80723
Practice Address - Country:US
Practice Address - Phone:205-427-2254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-28
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002034981223P0221X
MD15588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist