Provider Demographics
NPI:1649363268
Name:HEINSEN, GRETCHEN (DMD,MSCD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:
Last Name:HEINSEN
Suffix:
Gender:F
Credentials:DMD,MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 E COMMERCIAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4311
Mailing Address - Country:US
Mailing Address - Phone:954-667-6507
Mailing Address - Fax:954-772-3663
Practice Address - Street 1:3037 E COMMERCIAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4311
Practice Address - Country:US
Practice Address - Phone:954-667-6507
Practice Address - Fax:954-772-3663
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN98611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics