Provider Demographics
NPI:1851417935
Name:HEIDENREICH, EUGENE WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:WILLIAM
Last Name:HEIDENREICH
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 1:1080 BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-1833
Mailing Address - Country:US
Mailing Address - Phone:951-845-7300
Mailing Address - Fax:951-845-7652
Practice Address - Street 1:1080 BEAUMONT AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-1833
Practice Address - Country:US
Practice Address - Phone:951-845-7300
Practice Address - Fax:951-845-7652
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223G0001X1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice