Provider Demographics
NPI:1386955888
Name:BRYCE HEINER, DMD, MD, LLC
Entity type:Organization
Organization Name:BRYCE HEINER, DMD, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:575-522-8800
Mailing Address - Street 1:2103 TELSHOR CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8245
Mailing Address - Country:US
Mailing Address - Phone:575-522-8800
Mailing Address - Fax:575-522-8800
Practice Address - Street 1:2103 TELSHOR CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8245
Practice Address - Country:US
Practice Address - Phone:575-522-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3068261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386955888OtherGROUP NPI