Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DD3068 | NM |
NPI | 1013186584 |
---|---|
Provider Name | Dr. Bryce Heiner |
First Address | Las Cruces, NM 88011-8245 |
Second Address | Las Cruces, NM 88011-8245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2008 |
Last Update Date | 27/05/2016 |