Provider Demographics
NPI:1801876503
Name:HERITIER, DENNIS J (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:HERITIER
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 1:6284 RUCKER RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4865
Mailing Address - Country:US
Mailing Address - Phone:317-255-5285
Mailing Address - Fax:317-255-0548
Practice Address - Street 1:6284 RUCKER RD
Practice Address - Street 2:SUITE G
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4865
Practice Address - Country:US
Practice Address - Phone:317-255-5285
Practice Address - Fax:317-255-0548
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007997A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist