Provider Demographics
NPI:1316026628
Name:GARY J. HECKENBERGER, D.D.S., P.C.
Entity Type:Organization
Organization Name:GARY J. HECKENBERGER, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HECKENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:610-866-7021
Mailing Address - Street 1:1234 EATON AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1806
Mailing Address - Country:US
Mailing Address - Phone:610-866-7021
Mailing Address - Fax:610-866-7021
Practice Address - Street 1:1234 EATON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-1806
Practice Address - Country:US
Practice Address - Phone:610-866-7021
Practice Address - Fax:610-866-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023663L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA167046OtherUCCI PROVIDER ID