Provider Demographics
NPI:1578615688
Name:HELITZER, EDWIN JESSE (DMD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:JESSE
Last Name:HELITZER
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 1:195 SOUTH ST
Mailing Address - Street 2:SUITE 2 DOCTORS PARK
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6831
Mailing Address - Country:US
Mailing Address - Phone:413-447-7622
Mailing Address - Fax:
Practice Address - Street 1:195 SOUTH DOCTORS PARK
Practice Address - Street 2:SUITE 2
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6831
Practice Address - Country:US
Practice Address - Phone:413-447-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152471223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health