Provider Demographics
NPI:1437274370
Name:OCASIO-HEIL, JOHANNA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:M
Last Name:OCASIO-HEIL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOHANNA
Other - Middle Name:M
Other - Last Name:OCASIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:53 CHARLTON LANE
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2611
Mailing Address - Country:US
Mailing Address - Phone:617-838-4877
Mailing Address - Fax:
Practice Address - Street 1:391 NORWICH WESTERLY RD
Practice Address - Street 2:2
Practice Address - City:NORTH STONIGTON
Practice Address - State:CT
Practice Address - Zip Code:06382
Practice Address - Country:US
Practice Address - Phone:860-848-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTD94951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice