Provider Demographics
NPI:1215920087
Name:HEYN, ROSS ALAN (DDS)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:ALAN
Last Name:HEYN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2412
Mailing Address - Country:US
Mailing Address - Phone:916-624-8597
Mailing Address - Fax:916-624-7493
Practice Address - Street 1:4990 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2412
Practice Address - Country:US
Practice Address - Phone:916-624-8597
Practice Address - Fax:916-624-7493
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3981001OtherDENTICAL
656987OtherUNITED CONCORDIA