Provider Demographics
NPI:1639130883
Name:HEYDER, MARKUS P (DDS)
Entity Type:Individual
Prefix:MR
First Name:MARKUS
Middle Name:P
Last Name:HEYDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704-B. N. CROATAN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-9216
Mailing Address - Country:US
Mailing Address - Phone:252-261-7700
Mailing Address - Fax:252-261-1770
Practice Address - Street 1:3704-B N. CROATAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-9216
Practice Address - Country:US
Practice Address - Phone:252-261-7700
Practice Address - Fax:252-261-1770
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77751223G0001X, 122300000X
NC7715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902UBMedicaid
NC89902U8Medicaid