Provider Demographics
NPI:1982576534
Name:HERON POINTE DENTAL, PLLC
Entity type:Organization
Organization Name:HERON POINTE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-571-3417
Mailing Address - Street 1:3510 N BERTHOUD PARKWAY
Mailing Address - Street 2:UNIT B
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513
Mailing Address - Country:US
Mailing Address - Phone:970-746-9006
Mailing Address - Fax:970-746-9005
Practice Address - Street 1:3510 N BERTHOUD PARKWAY
Practice Address - Street 2:UNIT B
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513
Practice Address - Country:US
Practice Address - Phone:970-746-9006
Practice Address - Fax:970-746-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty