Provider Demographics
NPI:1134268089
Name:HEINLE, NORBERT P (DMD)
Entity type:Individual
Prefix:
First Name:NORBERT
Middle Name:P
Last Name:HEINLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2209
Mailing Address - Country:US
Mailing Address - Phone:814-724-1861
Mailing Address - Fax:814-425-2556
Practice Address - Street 1:764 KENNEDY ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2209
Practice Address - Country:US
Practice Address - Phone:814-724-1861
Practice Address - Fax:814-425-2556
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016179L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT-27992Medicare UPIN