Provider Demographics
NPI:1598970014
Name:HEFFERNAN, MYLES F JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYLES
Middle Name:F
Last Name:HEFFERNAN
Suffix:JR
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:SOUTH LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01561
Mailing Address - Country:US
Mailing Address - Phone:978-365-5643
Mailing Address - Fax:978-368-0145
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01561
Practice Address - Country:US
Practice Address - Phone:978-365-5643
Practice Address - Fax:978-368-0145
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN170361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice