Provider Demographics
NPI:1487715447
Name:HEINNICH, DAVID J (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:HEINNICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:J
Other - Last Name:HEINNICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:103 NORTH LLANO
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624
Mailing Address - Country:US
Mailing Address - Phone:830-997-2550
Mailing Address - Fax:830-997-2550
Practice Address - Street 1:103 NORTH LLANO
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624
Practice Address - Country:US
Practice Address - Phone:830-997-2550
Practice Address - Fax:830-997-2550
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice