Provider Demographics
NPI:1316013261
Name:DR JAMES G HEFFERNAN DDS,PC
Entity type:Organization
Organization Name:DR JAMES G HEFFERNAN DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:HEFFERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-208-7668
Mailing Address - Street 1:403 WILLIAMSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1091
Mailing Address - Country:US
Mailing Address - Phone:630-406-5790
Mailing Address - Fax:630-208-7677
Practice Address - Street 1:403 WILLIAMSBURG AVE
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-1091
Practice Address - Country:US
Practice Address - Phone:630-406-5790
Practice Address - Fax:630-208-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty