Glenn Scott Heller, DMD
Individual provider Active NPI Dentist · Branchville, NJ
NPI 1164537791 · NPPES record last updated Dec 31, 2007
Key facts
- NPI
- 1164537791
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 22D102266500 (NJ)
- Practice address
- 1 Country Lane
Branchville, NJ 07826 - Phone
- (973) 948-5000
- Fax
- (973) 948-2280
- NPI assigned
- Aug 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22D102266500 | NJ | MD | Dentist |
| DS037172 | PA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Okeson Family Dental, PC | General Practice | Past | Accepting new patients |
| The Suite Tooth, LLC | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22D102266500 | NJ | Yes |
| General Practice Dentistry | 1223G0001X | DS037172 | PA |
Addresses
Primary practice location
1 Country Lane
Branchville, NJ 07826
Mailing address
69 Birch Pkwy
Sparta, NJ 07871-1225
Phone (973) 868-9075
Other providers in Branchville, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.