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General NPI Number Information
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NPI Number | 1871690727
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Entity Type | Individual
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Provider Name | SUSAN M HEINZEN DDS
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 150 S TULSA AVE
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-4600
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Country | US
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Telephone | 479-968-2100
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Fax | 479-968-2107
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Provider Business Mailing Address
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Address Line | 150 S TULSA AVE
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-4600
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Country | US
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Telephone | 916-335-7510
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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 | 54285
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4149
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License Number State | AR
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