Provider Demographics
NPI:1255548772
Name:HEIDEN DENTAL OFFICE
Entity type:Organization
Organization Name:HEIDEN DENTAL OFFICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:HEIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-662-1225
Mailing Address - Street 1:187 WARLEY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4442
Mailing Address - Country:US
Mailing Address - Phone:843-662-1225
Mailing Address - Fax:843-662-1787
Practice Address - Street 1:187 WARLEY ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4442
Practice Address - Country:US
Practice Address - Phone:843-662-1225
Practice Address - Fax:843-662-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty