Benjamin Charles Heffter, DDS
Individual provider Active NPI General Practice Dentistry · Jackson, WI
NPI 1679928188 · NPPES record last updated Jul 17, 2019
Key facts
- NPI
- 1679928188
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 1001319-15 (WI)
- Practice address
- N168W20060 Main St
Jackson, WI 53037-9380 - Phone
- (262) 677-3003
- NPI assigned
- May 3, 2016
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161209001454 | WI | Order and Referring Only - Dentist |
2365722204 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001319-15 | WI | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1001319-15 | WI | Yes |
Addresses
Primary practice location
N168W20060 Main St
Jackson, WI 53037-9380
Mailing address
2640 N 83Rd St
Wauwatosa, WI 53213-1029
Phone (630) 908-0745
Other providers in Jackson, WI
- Scott McLean Foley
- Froedtert & the Medical College of Wisconsin Community Physicians Inc
- Traci Gibb
- Great Horizon Transportation LLC
- Hands on Therapy Specialists, LLC
- Kristin Hillman
- Holt Holten
- Jackson Family Dentistry LLC
- Jackson Town & Country Dental LLC
- Jackson Vision Center, LLC
All providers in Jackson, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.