Provider Demographics
NPI:1467189183
Name:HEINZ ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:HEINZ ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANGEMERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-656-4155
Mailing Address - Street 1:6208 KALAMAZOO AVE SE STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7893
Mailing Address - Country:US
Mailing Address - Phone:616-656-4155
Mailing Address - Fax:616-656-4156
Practice Address - Street 1:158 MARCELL DR NE STE A
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1393
Practice Address - Country:US
Practice Address - Phone:616-951-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty