Provider Demographics
NPI:1962414466
Name:HEISLER, ELIOT M (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:ELIOT
Middle Name:M
Last Name:HEISLER
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Gender:M
Credentials:DDS, PC
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Mailing Address - Street 1:45 N STATION PLZ
Mailing Address - Street 2:SUITE 216
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5011
Mailing Address - Country:US
Mailing Address - Phone:516-829-2001
Mailing Address - Fax:516-466-4585
Practice Address - Street 1:45 N STATION PLZ
Practice Address - Street 2:SUITE 216
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5011
Practice Address - Country:US
Practice Address - Phone:516-829-2001
Practice Address - Fax:516-466-4585
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0443541223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics