Provider Demographics
NPI:1750814166
Name:HEINECKE FAMILY DENTISTRY
Entity type:Organization
Organization Name:HEINECKE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:HEINECKE
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-796-0917
Mailing Address - Street 1:7135 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-1048
Mailing Address - Country:US
Mailing Address - Phone:352-796-0917
Mailing Address - Fax:352-515-5761
Practice Address - Street 1:103 BELL AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2603
Practice Address - Country:US
Practice Address - Phone:352-796-3380
Practice Address - Fax:352-796-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 220011223G0001X
FLDN110901223G0001X
FLDN 220001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty