Provider Demographics
NPI:1730597378
Name:HEESCH, MAURINE ELIZABETH (DDS)
Entity type:Individual
Prefix:
First Name:MAURINE
Middle Name:ELIZABETH
Last Name:HEESCH
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 1:1435 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2433
Mailing Address - Country:US
Mailing Address - Phone:402-727-9100
Mailing Address - Fax:402-753-9918
Practice Address - Street 1:1435 E 23RD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2433
Practice Address - Country:US
Practice Address - Phone:402-727-9100
Practice Address - Fax:402-753-9918
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1053122300000X
NE74251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentist