MEDICARE: TED J HEINZ 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	019018659	IL

General Provider Information

NPI Number	:	1215056643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TED J HEINZ D.D.S.

Provider Business Mailing Address
First Line	:	518 WAIKIKI DR
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-1167
Country	:	US
Telephone Number	:	847-298-0341
Fax Number	:	847-663-1424

Provider Business Practice Location Address
First Line	:	5901 DEMPSTER ST STE 202
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3023
Country	:	US
Telephone Number	:	847-663-1422
Fax Number	:	847-663-1424

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	01/22/2010

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