Provider Demographics
NPI:1699542761
Name:HEITZLER, JENNA ILANA (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:ILANA
Last Name:HEITZLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 GRAND ST APT 506
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2253
Mailing Address - Country:US
Mailing Address - Phone:914-815-4873
Mailing Address - Fax:
Practice Address - Street 1:1313 GRAND ST APT 506
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2253
Practice Address - Country:US
Practice Address - Phone:914-815-4873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI030074001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics