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General NPI Number Information
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NPI Number | 1982793816
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Entity Type | Individual
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Provider Name | THOMAS EUGENE HEINRICHS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 305 E BROADWAY ST
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City | BOLIVAR
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State | MO
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Zip | 65613-1625
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Country | US
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Telephone | 417-326-4113
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Fax |
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Provider Business Mailing Address
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Address Line | 305 E BROADWAY ST
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City | BOLIVAR
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State | MO
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Zip | 65613-1625
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Country | US
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Telephone | 417-326-4113
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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 | DW36082
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2020031835
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License Number State | MO
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