Healthcare Provider Details

I. General information

NPI: 1407839244
Provider Name (Legal Business Name): ALAN R HELLER D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 MALLARD DR STE 201
LAUREL MD
20708-3199
US

IV. Provider business mailing address

9811 MALLARD DR STE 201
LAUREL MD
20708-3199
US

V. Phone/Fax

Practice location:
  • Phone: 301-490-2882
  • Fax: 240-800-6200
Mailing address:
  • Phone: 301-490-2882
  • Fax: 240-800-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10911
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: