Provider Demographics
NPI:1053587923
Name:HEINEMANN, PAUL ANTON (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTON
Last Name:HEINEMANN
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 1:10187 CLEARY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1026
Mailing Address - Country:US
Mailing Address - Phone:954-577-8736
Mailing Address - Fax:954-577-8756
Practice Address - Street 1:10187 CLEARY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1026
Practice Address - Country:US
Practice Address - Phone:954-577-8736
Practice Address - Fax:954-577-8756
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist