MEDICARE: DR. JOHN J HEFFRON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry	5594	MD

General Provider Information

NPI Number	:	1659353423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN J HEFFRON DDS

Provider Business Mailing Address
First Line	:	3450 OLD WASHINGTON RD
Second Line	:	SUITE 201
City	:	WALDORF
State	:	MD
Zip	:	20602-3248
Country	:	US
Telephone Number	:	301-645-6911
Fax Number	:	301-843-0083

Provider Business Practice Location Address
First Line	:	3450 OLD WASHINGTON RD
Second Line	:	SUITE 201
City	:	WALDORF
State	:	MD
Zip	:	20602-3248
Country	:	US
Telephone Number	:	301-645-6911
Fax Number	:	301-843-0083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	11/07/2013

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