Provider Demographics
NPI:1265505648
Name:HEINZELMANN, KARL ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:ANDREW
Last Name:HEINZELMANN
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 1:430 BROOK MANOR CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-3242
Mailing Address - Country:US
Mailing Address - Phone:770-360-9004
Mailing Address - Fax:770-475-2780
Practice Address - Street 1:11775 POINTE PL
Practice Address - Street 2:SUITE 104
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4636
Practice Address - Country:US
Practice Address - Phone:770-475-3398
Practice Address - Fax:770-475-2780
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92501223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics