Provider Demographics
NPI:1164651378
Name:HEINTZELMAN, EMILY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:C
Last Name:HEINTZELMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 S. PARK DR.
Mailing Address - Street 2:
Mailing Address - City:MC COMB
Mailing Address - State:OH
Mailing Address - Zip Code:45858-0788
Mailing Address - Country:US
Mailing Address - Phone:419-293-2335
Mailing Address - Fax:419-293-2512
Practice Address - Street 1:269 S. PARK DR.
Practice Address - Street 2:
Practice Address - City:MC COMB
Practice Address - State:OH
Practice Address - Zip Code:45858-0788
Practice Address - Country:US
Practice Address - Phone:419-293-2335
Practice Address - Fax:419-293-2512
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH230441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice