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General NPI Number Information
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NPI Number | 1053841197
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Entity Type | Individual
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Provider Name | JIEAN JOSEPH HEIFETZ-LI DMD, MPH
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Gender | Male
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 246 GOOSE LN STE 204
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City | GUILFORD
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State | CT
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Zip | 06437-2186
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Country | US
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Telephone | 203-453-4381
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Fax |
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Provider Business Mailing Address
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Address Line | 246 GOOSE LN STE 204
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City | GUILFORD
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State | CT
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Zip | 06437-2186
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Country | US
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Telephone | 203-453-4381
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 13319
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License Number State | CT
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