Provider Demographics
NPI:1033205257
Name:HEIDENREICH, ERICH (DDS, PLLC)
Entity Type:Individual
Prefix:DR
First Name:ERICH
Middle Name:
Last Name:HEIDENREICH
Suffix:
Gender:M
Credentials:DDS, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1522
Mailing Address - Country:US
Mailing Address - Phone:269-781-4600
Mailing Address - Fax:
Practice Address - Street 1:128 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1522
Practice Address - Country:US
Practice Address - Phone:269-781-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0150371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice