Healthcare Provider Details

I. General information

NPI: 1891892444
Provider Name (Legal Business Name): DIANE BAVER HELLER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S BEDFORD RD SUITE 410
MOUNT KISCO NY
10549-3439
US

IV. Provider business mailing address

750 KAPPOCK ST APT 711
BRONX NY
10463-4612
US

V. Phone/Fax

Practice location:
  • Phone: 914-241-1177
  • Fax:
Mailing address:
  • Phone: 718-796-6728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number041847-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number008144
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: