Healthcare Provider Details

I. General information

NPI: 1417233750
Provider Name (Legal Business Name): CHRISTINE MARIE O'HEA DMD MDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HAVEN AVE
NEW YORK NY
10032-2645
US

IV. Provider business mailing address

5 CRAIG LN
CHESTER NJ
07930-2228
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-0107
  • Fax:
Mailing address:
  • Phone: 973-573-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDI02071000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number057228
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: