Provider Demographics
NPI:1093828469
Name:HEITLINGER, SANFORD (DDS)
Entity Type:Individual
Prefix:
First Name:SANFORD
Middle Name:
Last Name:HEITLINGER
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 1:33 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2620
Mailing Address - Country:US
Mailing Address - Phone:737-777-9077
Mailing Address - Fax:732-777-9341
Practice Address - Street 1:33 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2620
Practice Address - Country:US
Practice Address - Phone:737-777-9077
Practice Address - Fax:732-777-9341
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ117531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice