Healthcare Provider Details

I. General information

NPI: 1083833941
Provider Name (Legal Business Name): JAMES O HEY JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 N BRINTON AVE
DIXON IL
61021-1610
US

IV. Provider business mailing address

724 N BRINTON AVE
DIXON IL
61021-1610
US

V. Phone/Fax

Practice location:
  • Phone: 815-288-4731
  • Fax: 815-288-4939
Mailing address:
  • Phone: 815-288-4731
  • Fax: 815-288-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19A14580
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: