Provider Demographics
NPI:1073778668
Name:HEITKE, LOUIS H (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:H
Last Name:HEITKE
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 1:122 E JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2120
Mailing Address - Country:US
Mailing Address - Phone:608-257-0116
Mailing Address - Fax:608-257-8901
Practice Address - Street 1:122 E JOHNSON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2120
Practice Address - Country:US
Practice Address - Phone:608-257-0116
Practice Address - Fax:608-257-8901
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33406200Medicaid