Provider Demographics
NPI:1558857573
Name:HEFFEZ, ERIN ILYSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ILYSE
Last Name:HEFFEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-2917
Mailing Address - Country:US
Mailing Address - Phone:847-347-4732
Mailing Address - Fax:847-945-7812
Practice Address - Street 1:75 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090
Practice Address - Country:US
Practice Address - Phone:847-465-0800
Practice Address - Fax:947-465-0053
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0317721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice