Provider Demographics
NPI:1053435594
Name:HEINEMANN, MARK R (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:HEINEMANN
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Gender:M
Credentials:DDS
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Mailing Address - Street 1:9633 LEVIN RD NW
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8131
Mailing Address - Country:US
Mailing Address - Phone:360-692-3030
Mailing Address - Fax:360-692-7720
Practice Address - Street 1:9633 LEVIN RD NW
Practice Address - Street 2:SUITE 206
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8131
Practice Address - Country:US
Practice Address - Phone:360-692-3030
Practice Address - Fax:360-692-7720
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA38161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics