Provider Demographics
NPI:1669635512
Name:HEITZMANN, EMILY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ANN
Last Name:HEITZMANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:DASINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:512 ELLERSLIE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8327
Mailing Address - Country:US
Mailing Address - Phone:601-750-3701
Mailing Address - Fax:
Practice Address - Street 1:112 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2305
Practice Address - Country:US
Practice Address - Phone:601-707-5585
Practice Address - Fax:601-707-5586
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3491-08122300000X
MS464-131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist