Provider Demographics
NPI:1588719611
Name:HEINRICH, GAYLE M (DDS)
Entity type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:M
Last Name:HEINRICH
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 1:2300 N MAYFAIR RD
Mailing Address - Street 2:#245
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1505
Mailing Address - Country:US
Mailing Address - Phone:414-257-3103
Mailing Address - Fax:414-476-0037
Practice Address - Street 1:2300 N MAYFAIR RD
Practice Address - Street 2:#245
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1505
Practice Address - Country:US
Practice Address - Phone:414-257-3103
Practice Address - Fax:414-476-0037
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5002038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist