Individual provider Active NPI

Jeffrey Heinz, DDS, MSD

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Rockford, MI
National Provider Identifier
1275946113
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
2901021273 Issued in MI
Practice address
158 Marcell Dr NE Ste a
Rockford, MI 49341-1393
Phone
(616) 951-3006
NPI assigned
Jun 9, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901021273 MI
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 2901021273 MI Primary

Addresses

Primary practice location

158 Marcell Dr NE Ste a
Rockford, MI 49341-1393

Mailing address

158 Marcell Dr NE Ste a
Rockford, MI 49341-1393
Phone (616) 951-3006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2901021273MIMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Heinz Orthodontics PLLC Orthodontics and Dentofacial Orthopedics CurrentSince Aug 7, 2022 Accepting new patients
Fortson Family Dentistry, P.C. PastSince May 10, 2024 Accepting new patients
Raymond a Fortson Jr & Associates DDS PC Dentist Past Accepting new patients

Locations

158 Marcell Dr NE
Ste A
Rockford, MI 49341
Phone (616) 951-3006

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1275946113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 MARCELL DR NE STE A",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493411393",
            "telephone_number": "616-951-3006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 MARCELL DR NE STE A",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493411393",
            "telephone_number": "616-951-3006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINZ",
        "first_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "DDS, MSD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-09",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021273",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MI",
            "license": "2901021273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.