Provider Demographics
NPI:1548201361
Name:HEFFERNAN, DANIEL P (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:HEFFERNAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-1608
Mailing Address - Country:US
Mailing Address - Phone:513-574-7503
Mailing Address - Fax:513-574-7728
Practice Address - Street 1:6040 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1608
Practice Address - Country:US
Practice Address - Phone:513-574-7503
Practice Address - Fax:513-574-7728
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30016429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist