MEDICARE: DR. IVANA HEINLEIN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22DI01822700	NJ
2	122300000X	Dentist	10405	SC

General Provider Information

NPI Number	:	1093833071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVANA HEINLEIN D.D.S.

Provider Business Mailing Address
First Line	:	1223 S LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-6889
Country	:	US
Telephone Number	:	803-520-5580
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 S LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-6889
Country	:	US
Telephone Number	:	803-520-5580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	12/20/2024

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