Individual
HEINERY AREVALO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
6100 WASHINGTON AVE STE F2, MOUNT PLEASANT, WI 53406-4000
(262) 999-9998
Mailing address
420 S CLINTON ST APT 409A, CHICAGO, IL 60607-3809
(630) 656-2659
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019.033683
IL
1223G0001X
General Practice Dentistry
Primary
6001069-15
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100216253
—
WI
Enumeration date
06/10/2022
Last updated
12/17/2023
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