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General NPI Number Information
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NPI Number | 1467189183
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Entity Type | Organization
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Legal Business Name | HEINZ ORTHODONTICS PLLC
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 158 MARCELL DR NE STE A
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City | ROCKFORD
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State | MI
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Zip | 49341-1393
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Country | US
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Telephone | 616-951-3006
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Fax |
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Provider Business Mailing Address
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Address Line | 6208 KALAMAZOO AVE SE STE 3
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-7893
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Country | US
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Telephone | 616-656-4155
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Fax | 616-656-4156
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | MARY VANGEMERT
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Credential |
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Telephone | 616-656-4155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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