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General NPI Number Information
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NPI Number | 1316013261
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Entity Type | Organization
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Legal Business Name | DR JAMES G HEFFERNAN DDS,PC
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 403 WILLIAMSBURG AVE
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City | GENEVA
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State | IL
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Zip | 60134-1091
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Country | US
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Telephone | 630-406-5790
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Fax | 630-208-7677
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Provider Business Mailing Address
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Address Line | 403 WILLIAMSBURG AVE
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City | GENEVA
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State | IL
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Zip | 60134-1091
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Country | US
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Telephone | 630-406-5790
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Fax | 630-208-7677
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES GREGORY HEFFERNAN
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Credential | D.D.S.
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Telephone | 630-208-7668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State | IL
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