Provider Demographics
NPI:1104232172
Name:LISA HEINRICH-NULL DDS
Entity type:Organization
Organization Name:LISA HEINRICH-NULL DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINRICH-NULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-575-8735
Mailing Address - Street 1:6701 N NAVARRO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1513
Mailing Address - Country:US
Mailing Address - Phone:361-575-8735
Mailing Address - Fax:361-572-9840
Practice Address - Street 1:6701 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1513
Practice Address - Country:US
Practice Address - Phone:361-575-8735
Practice Address - Fax:361-572-9840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty