Provider Demographics
NPI:1659798759
Name:HEFFERNAN, BRITTANY LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:LEIGH
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:BRITTANY
Other - Middle Name:LEIGH
Other - Last Name:LIPINSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:12165 ELM STREET
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853
Practice Address - Country:US
Practice Address - Phone:410-651-5151
Practice Address - Fax:410-651-4256
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLL677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid