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General NPI Number Information
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NPI Number | 1306157946
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Entity Type | Individual
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Provider Name | DAVID JOHN HEIDENREICH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 7868 REA RD STE B
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City | CHARLOTTE
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State | NC
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Zip | 28277-6548
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Country | US
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Telephone | 402-659-9729
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 S CHURCH ST APT 126
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City | CHARLOTTE
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State | NC
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Zip | 28203-4017
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Country | US
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Telephone | 402-659-9729
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2010018671
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License Number State | MO
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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 | 6950
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9091
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License Number State | NC
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