Provider Demographics
NPI:1811160617
Name:JERRY E. HECK, D.M.D.,INC.
Entity type:Organization
Organization Name:JERRY E. HECK, D.M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HECK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:937-444-3311
Mailing Address - Street 1:470 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-9452
Mailing Address - Country:US
Mailing Address - Phone:937-444-3311
Mailing Address - Fax:937-444-1720
Practice Address - Street 1:470 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-9452
Practice Address - Country:US
Practice Address - Phone:937-444-3311
Practice Address - Fax:937-444-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH204581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty