Provider Demographics
NPI:1306861323
Name:HEINTSCHEL, GREGORY PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PAUL
Last Name:HEINTSCHEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:218 W GARFIELD MICHIGAN COMMUNITY DENTAL CLINICS INC
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1631
Mailing Address - Country:US
Mailing Address - Phone:231-547-7638
Mailing Address - Fax:231-547-7955
Practice Address - Street 1:3434 M-119
Practice Address - Street 2:SUITE B MICHIGAN COMMUNITY DENTAL CLINICS INC
Practice Address - City:HARBOR SPINGS
Practice Address - State:MI
Practice Address - Zip Code:49740
Practice Address - Country:US
Practice Address - Phone:231-348-3970
Practice Address - Fax:231-348-3946
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH19093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist