Provider Demographics
NPI:1215056643
Name:HEINZ, TED J (DDS)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:J
Last Name:HEINZ
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 1:518 WAIKIKI DR
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1167
Mailing Address - Country:US
Mailing Address - Phone:847-298-0341
Mailing Address - Fax:847-663-1424
Practice Address - Street 1:5901 DEMPSTER ST STE 202
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3023
Practice Address - Country:US
Practice Address - Phone:847-663-1422
Practice Address - Fax:847-663-1424
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190186591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice