Provider Demographics
NPI:1366525404
Name:HEINTZ, WILLIAM CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:HEINTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 S FAIRMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-3202
Mailing Address - Country:US
Mailing Address - Phone:618-465-7423
Mailing Address - Fax:618-465-5518
Practice Address - Street 1:2828 HOMER M ADAMS PKWY
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4855
Practice Address - Country:US
Practice Address - Phone:618-465-7423
Practice Address - Fax:618-465-5518
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics