Provider Demographics
NPI:1801304324
Name:HEIN DENTAL GROUP PC
Entity type:Organization
Organization Name:HEIN DENTAL GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-405-9390
Mailing Address - Street 1:9510 N MERIDIAN ST STE 250
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240
Mailing Address - Country:US
Mailing Address - Phone:317-660-1914
Mailing Address - Fax:
Practice Address - Street 1:9510 N MERIDIAN ST STE 250
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1334
Practice Address - Country:US
Practice Address - Phone:317-660-1914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009868A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty