Provider Demographics
NPI:1073745386
Name:HEINTZ, JASON T (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:T
Last Name:HEINTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-2335
Mailing Address - Country:US
Mailing Address - Phone:406-883-5544
Mailing Address - Fax:406-883-5420
Practice Address - Street 1:102 1ST AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2335
Practice Address - Country:US
Practice Address - Phone:406-883-5544
Practice Address - Fax:406-883-5420
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2363122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist