Provider Demographics
NPI:1295748606
Name:HEITZ, LYNDEN E (DDS)
Entity type:Individual
Prefix:DR
First Name:LYNDEN
Middle Name:E
Last Name:HEITZ
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 1:1547 S HIGGINS AVE
Mailing Address - Street 2:SUITE D BITTERROOT BUILDING
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801
Mailing Address - Country:US
Mailing Address - Phone:406-542-2742
Mailing Address - Fax:406-543-4358
Practice Address - Street 1:1547 S HIGGINS AVE
Practice Address - Street 2:SUITE D BITTERROOT BUILDING
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-542-2742
Practice Address - Fax:406-543-4358
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist