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General NPI Number Information
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NPI Number | 1093833071
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Entity Type | Individual
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Provider Name | IVANA HEINLEIN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1223 S LAKE DR
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City | LEXINGTON
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State | SC
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Zip | 29073-6889
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Country | US
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Telephone | 803-520-5580
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Fax |
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Provider Business Mailing Address
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Address Line | 1223 S LAKE DR
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City | LEXINGTON
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State | SC
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Zip | 29073-6889
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Country | US
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Telephone | 803-520-5580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI01822700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10405
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License Number State | SC
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