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General NPI Number Information
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NPI Number | 1306861323
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Entity Type | Individual
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Provider Name | GREGORY PAUL HEINTSCHEL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | 3434 M-119 SUITE B MICHIGAN COMMUNITY DENTAL CLINICS INC
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City | HARBOR SPINGS
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State | MI
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Zip | 49740
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Country | US
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Telephone | 231-348-3970
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Fax | 231-348-3946
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Provider Business Mailing Address
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Address Line | PO BOX 219 218 W GARFIELD MICHIGAN COMMUNITY DENTAL CLINICS INC
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City | CHARLEVOIX
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State | MI
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Zip | 49720-1631
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Country | US
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Telephone | 231-547-7638
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Fax | 231-547-7955
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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 | 19093
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License Number State | OH
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