Provider Demographics
NPI:1508968033
Name:HELLER, A. STEPHEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:A.
Middle Name:STEPHEN
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 1:24953 PASEO DE VALENCIA
Mailing Address - Street 2:SUITE 18C
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4342
Mailing Address - Country:US
Mailing Address - Phone:949-830-4270
Mailing Address - Fax:949-830-1778
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:SUITE 18C
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4342
Practice Address - Country:US
Practice Address - Phone:949-830-4270
Practice Address - Fax:949-830-1778
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD252631223E0200X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223P0300XDental ProvidersDentistPeriodontics