Provider Demographics
NPI:1699865998
Name:HEYDE, JANE L (DDS)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:L
Last Name:HEYDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 E. 225 S.
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-6213
Mailing Address - Country:US
Mailing Address - Phone:574-269-2825
Mailing Address - Fax:
Practice Address - Street 1:2212 E. 225 S.
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-6213
Practice Address - Country:US
Practice Address - Phone:574-269-2825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120083951223G0001X
IN12008395A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist