Provider Demographics
NPI:1962134882
Name:HEINBACH, MARYANN (RDH)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:HEINBACH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10043 53RD WAY S APT 2404
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-1353
Mailing Address - Country:US
Mailing Address - Phone:704-488-5978
Mailing Address - Fax:
Practice Address - Street 1:800 CLEMATIS ST STE 1-120
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5107
Practice Address - Country:US
Practice Address - Phone:561-671-4177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28812124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist