Provider Demographics
NPI:1730327487
Name:HEINZE, PATRICIA MASIELLO (DDS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MASIELLO
Last Name:HEINZE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 DOGWOOD AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3409
Mailing Address - Country:US
Mailing Address - Phone:516-483-8669
Mailing Address - Fax:
Practice Address - Street 1:340 DOGWOOD AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3409
Practice Address - Country:US
Practice Address - Phone:516-483-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist