Provider Demographics
NPI:1568658573
Name:ERICH HEIDENREICH, DDS, PLLC
Entity Type:Organization
Organization Name:ERICH HEIDENREICH, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDENREICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-781-4600
Mailing Address - Street 1:128 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1522
Mailing Address - Country:US
Mailing Address - Phone:269-781-4600
Mailing Address - Fax:
Practice Address - Street 1:128 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1522
Practice Address - Country:US
Practice Address - Phone:269-781-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0150371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty