Provider Demographics
NPI:1861413692
Name:HELLER, MARK JEOFFREY (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JEOFFREY
Last Name:HELLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 NORTHERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5309
Mailing Address - Country:US
Mailing Address - Phone:516-482-0440
Mailing Address - Fax:516-482-5046
Practice Address - Street 1:935 NORTHERN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5309
Practice Address - Country:US
Practice Address - Phone:516-482-0440
Practice Address - Fax:516-482-5046
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0348351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice