Healthcare Provider Details

I. General information

NPI: 1508968033
Provider Name (Legal Business Name): A. STEPHEN HELLER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24953 PASEO DE VALENCIA SUITE 18C
LAGUNA HILLS CA
92653-4342
US

IV. Provider business mailing address

24953 PASEO DE VALENCIA SUITE 18C
LAGUNA HILLS CA
92653-4342
US

V. Phone/Fax

Practice location:
  • Phone: 949-830-4270
  • Fax: 949-830-1778
Mailing address:
  • Phone: 949-830-4270
  • Fax: 949-830-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD25263
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD25263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: