Provider Demographics
NPI:1942473178
Name:C. R. HEIRTZLER, JR., D.D.S., INC.
Entity Type:Organization
Organization Name:C. R. HEIRTZLER, JR., D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEIRTZLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-962-5311
Mailing Address - Street 1:3312 MEDICAL TRIANGLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-2424
Mailing Address - Country:US
Mailing Address - Phone:409-962-5311
Mailing Address - Fax:409-963-3192
Practice Address - Street 1:3312 MEDICAL TRIANGLE DRIVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2424
Practice Address - Country:US
Practice Address - Phone:409-962-5311
Practice Address - Fax:409-963-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty