MEDICARE: DR. GRETCHEN HEINSEN D.M.D.,M.SC.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	DN9861	FL

General Provider Information

NPI Number	:	1649363268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRETCHEN HEINSEN D.M.D.,M.SC.D.

Provider Business Mailing Address
First Line	:	3037 E COMMERCIAL BLVD STE A
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4311
Country	:	US
Telephone Number	:	954-667-6507
Fax Number	:	954-772-3663

Provider Business Practice Location Address
First Line	:	3037 E COMMERCIAL BLVD STE A
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4311
Country	:	US
Telephone Number	:	954-667-6507
Fax Number	:	954-772-3663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	01/09/2018

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