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General NPI Number Information
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NPI Number | 1215056643
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Entity Type | Individual
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Provider Name | TED J HEINZ D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 01/22/2010
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Provider Practice Location Address
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Address Line | 5901 DEMPSTER ST STE 202
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City | MORTON GROVE
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State | IL
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Zip | 60053-3023
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Country | US
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Telephone | 847-663-1422
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Fax | 847-663-1424
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Provider Business Mailing Address
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Address Line | 518 WAIKIKI DR
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City | DES PLAINES
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State | IL
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Zip | 60016-1167
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Country | US
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Telephone | 847-298-0341
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Fax | 847-663-1424
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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 | 019018659
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License Number State | IL
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