Healthcare Provider Details

I. General information

NPI: 1558857573
Provider Name (Legal Business Name): ERIN ILYSE HEFFEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S MILWAUKEE AVE
WHEELING IL
60090
US

IV. Provider business mailing address

822 FOREST AVE
DEERFIELD IL
60015-2917
US

V. Phone/Fax

Practice location:
  • Phone: 847-465-0800
  • Fax: 947-465-0053
Mailing address:
  • Phone: 847-347-4732
  • Fax: 847-945-7812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.031772
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: