Provider Demographics
NPI:1679694244
Name:HEINLEIN, WALTER DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:DONALD
Last Name:HEINLEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 WAUKEGAN ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLANVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025
Mailing Address - Country:US
Mailing Address - Phone:847-729-4411
Mailing Address - Fax:847-729-4421
Practice Address - Street 1:1132 WAUKEGAN ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:GLANVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:847-729-4411
Practice Address - Fax:847-729-4421
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice