Advanced Dentistry - Heffernan DDS LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

ADVANCED DENTISTRY - HEFFERNAN DDS LLC

Practice address

1832 Pearl Rd
Brunswick, OH 44212-3252

Phone

(330) 460-3016

NPI assigned

Jul 13, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Heffernan, DDSNPI 1417217795

Title

Member

Phone

(614) 582-9617

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Heffernan Jr., D.D.S

  • General Practice Dentistry
  • Brunswick, OH
  • NPI 1417217795
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627344000000",
    "number": "1891367488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1832 PEARL RD",
            "city": "BRUNSWICK",
            "state": "OH",
            "postal_code": "442123252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1832 PEARL RD",
            "city": "BRUNSWICK",
            "state": "OH",
            "postal_code": "442123252",
            "telephone_number": "330-460-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTISTRY - HEFFERNAN DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-13",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A",
        "authorized_official_last_name": "HEFFERNAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "614-582-9617",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1417217795",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Brunswick, OH
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.