Provider Demographics
NPI:1174723845
Name:HEINLE, RONALD NEIL (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:NEIL
Last Name:HEINLE
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 1:740 PITTSFORD VICTOR RD
Mailing Address - Street 2:P.O. BOX 448
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3938
Mailing Address - Country:US
Mailing Address - Phone:585-248-2824
Mailing Address - Fax:585-248-2665
Practice Address - Street 1:740 PITTSFORD VICTOR RD, BOX 448
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3938
Practice Address - Country:US
Practice Address - Phone:585-248-2824
Practice Address - Fax:585-248-2665
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0413421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice