Healthcare Provider Details

I. General information

NPI: 1528579661
Provider Name (Legal Business Name): HEJLAWY DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ALAMO DR STE D
VACAVILLE CA
95688-4246
US

IV. Provider business mailing address

301 ALAMO DR STE D
VACAVILLE CA
95688-4246
US

V. Phone/Fax

Practice location:
  • Phone: 707-447-7576
  • Fax:
Mailing address:
  • Phone: 707-447-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMER HEJLAWY
Title or Position: PRESIDENT
Credential: DDS.MSD
Phone: 707-447-7576