Provider Demographics
NPI:1861594301
Name:A. STEPHEN HELLER, DMD, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:A. STEPHEN HELLER, DMD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:A.
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-830-4270
Mailing Address - Street 1:24953 PASEO DE VALENCIA
Mailing Address - Street 2:SUITE 18C
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4342
Mailing Address - Country:US
Mailing Address - Phone:949-830-4270
Mailing Address - Fax:949-830-1778
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:SUITE 18C
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4342
Practice Address - Country:US
Practice Address - Phone:949-830-4270
Practice Address - Fax:949-830-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252631223P0300X
CAD252631223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty