Provider Demographics
NPI:1033323365
Name:HEFFELFINGER, THOMAS B JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:HEFFELFINGER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4625
Mailing Address - Country:US
Mailing Address - Phone:301-469-9100
Mailing Address - Fax:301-469-6572
Practice Address - Street 1:9001 RIVER RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4625
Practice Address - Country:US
Practice Address - Phone:301-469-9100
Practice Address - Fax:301-469-6572
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3916122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH141792098830OtherDRIVERS LICENSE
MD3916OtherDENTAL LICENSE