Provider Demographics
NPI:1033139290
Name:HELLER, JOEL IRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:IRA
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 1:15 KENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1529
Mailing Address - Country:US
Mailing Address - Phone:516-536-7673
Mailing Address - Fax:
Practice Address - Street 1:282A SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4906
Practice Address - Country:US
Practice Address - Phone:516-764-6339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0335971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice