Provider Demographics
NPI:1649438573
Name:HEIDI M. GOEPP, D.D.S PLC
Entity type:Organization
Organization Name:HEIDI M. GOEPP, D.D.S PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOEPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-221-2228
Mailing Address - Street 1:2001 WESTOWN PKWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-1540
Mailing Address - Country:US
Mailing Address - Phone:515-221-2228
Mailing Address - Fax:515-221-1968
Practice Address - Street 1:2001 WESTOWN PKWY
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-1540
Practice Address - Country:US
Practice Address - Phone:515-221-2228
Practice Address - Fax:515-221-1968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA77871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty