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General NPI Number Information
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NPI Number | 1972129427
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Entity Type | Individual
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Provider Name | MATTHEW JOSEPH HEINZ DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2020
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 312 CENTER ST
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City | LAKE GENEVA
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State | WI
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Zip | 53147-1904
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Country | US
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Telephone | 262-248-8766
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Fax |
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Provider Business Mailing Address
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Address Line | 1567 EVERGREEN LN
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City | LAKE GENEVA
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State | WI
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Zip | 53147-9708
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Country | US
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Telephone | 262-903-9104
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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 | 105787
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 019.035975
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License Number State | IL
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