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General NPI Number Information
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NPI Number | 1942473178
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Entity Type | Organization
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Legal Business Name | C. R. HEIRTZLER, JR., D.D.S., INC.
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 3312 MEDICAL TRIANGLE DRIVE
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City | PORT ARTHUR
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State | TX
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Zip | 77642-2424
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Country | US
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Telephone | 409-962-5311
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Fax | 409-963-3192
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Provider Business Mailing Address
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Address Line | 3312 MEDICAL TRIANGLE DRIVE
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City | PORT ARTHUR
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State | TX
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Zip | 77642-2424
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Country | US
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Telephone | 409-962-5311
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Fax | 409-963-3192
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. CLARENCE R HEIRTZLER JR.
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Credential | D.D.S.
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Telephone | 409-962-5311
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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 | 6682
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License Number State | TX
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