Provider Demographics
NPI:1477996379
Name:HEIDRICH, PAUL D III (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:HEIDRICH
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 MIZELL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4117
Mailing Address - Country:US
Mailing Address - Phone:407-644-4441
Mailing Address - Fax:
Practice Address - Street 1:1950 MIZELL AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4117
Practice Address - Country:US
Practice Address - Phone:407-644-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist