Provider Demographics
NPI:1801056080
Name:HECKERT, RANDALL KAY JR (DMD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:KAY
Last Name:HECKERT
Suffix:JR
Gender:M
Credentials:DMD
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Mailing Address - Street 1:2787 HARRIS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4873
Mailing Address - Country:US
Mailing Address - Phone:707-443-6781
Mailing Address - Fax:707-443-6719
Practice Address - Street 1:2787 HARRIS ST
Practice Address - Street 2:SUITE A
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4873
Practice Address - Country:US
Practice Address - Phone:707-443-6781
Practice Address - Fax:707-443-6719
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2011-11-18
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Provider Licenses
StateLicense IDTaxonomies
AK13341223P0221X
CO104241223P0221X
CA609751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry