Provider Demographics
NPI:1184793630
Name:HEINRICH-NULL, LISA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:HEINRICH-NULL
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 1:801 CHAMPIONS ROW
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3317
Mailing Address - Country:US
Mailing Address - Phone:361-572-9686
Mailing Address - Fax:361-572-9840
Practice Address - Street 1:507 E BRAZOS ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5261
Practice Address - Country:US
Practice Address - Phone:361-575-8735
Practice Address - Fax:361-572-9840
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15164OtherSTATE DENTAL EXAMINERS