Provider Demographics
NPI:1528579661
Name:HEJLAWY DDS PC
Entity Type:Organization
Organization Name:HEJLAWY DDS PC
Other - Org Name:BLUE OAK ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:HEJLAWY
Authorized Official - Suffix:
Authorized Official - Credentials:DDSMSD
Authorized Official - Phone:707-447-7576
Mailing Address - Street 1:301 ALAMO DR STE D
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4246
Mailing Address - Country:US
Mailing Address - Phone:707-447-7576
Mailing Address - Fax:
Practice Address - Street 1:301 ALAMO DR STE D
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4246
Practice Address - Country:US
Practice Address - Phone:707-447-7576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1902229164OtherNPI
1528579661OtherNPI