Provider Demographics
NPI:1366304966
Name:MOUNTAIN SMILES - HECK FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:MOUNTAIN SMILES - HECK FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SR. MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-300-5933
Mailing Address - Street 1:5120 CONGRESSIONAL CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5236
Mailing Address - Country:US
Mailing Address - Phone:785-856-8550
Mailing Address - Fax:
Practice Address - Street 1:5120 CONGRESSIONAL CIR STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5236
Practice Address - Country:US
Practice Address - Phone:785-856-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental