Provider Demographics
NPI:1346251188
Name:HEIRTZLER, ELZIABETH MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELZIABETH
Middle Name:MARIE
Last Name:HEIRTZLER
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 1:4455 RIDGEWAY ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-3961
Mailing Address - Country:US
Mailing Address - Phone:225-654-5500
Mailing Address - Fax:225-654-6755
Practice Address - Street 1:4455 RIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3961
Practice Address - Country:US
Practice Address - Phone:225-654-5500
Practice Address - Fax:225-654-6755
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA41891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice