Provider Demographics
NPI:1053841197
Name:HEIFETZ-LI, JIEAN JOSEPH (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JIEAN JOSEPH
Middle Name:
Last Name:HEIFETZ-LI
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 GOOSE LN STE 204
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2186
Mailing Address - Country:US
Mailing Address - Phone:203-453-4381
Mailing Address - Fax:
Practice Address - Street 1:246 GOOSE LN STE 204
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2186
Practice Address - Country:US
Practice Address - Phone:203-453-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT133191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery