Provider Demographics
NPI:1205983988
Name:HEINE, MATTHEW P (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:P
Last Name:HEINE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:638 NEWTOWN YARDLEY RD
Mailing Address - Street 2:#1A
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1758
Mailing Address - Country:US
Mailing Address - Phone:215-605-3365
Mailing Address - Fax:215-968-3252
Practice Address - Street 1:638 NEWTOWN YARDLEY RD
Practice Address - Street 2:#1A
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1758
Practice Address - Country:US
Practice Address - Phone:215-605-3365
Practice Address - Fax:215-968-3252
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0360991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice