Provider Demographics
NPI:1811012057
Name:HECKERT, LYNNE FISHER (DDS JD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:FISHER
Last Name:HECKERT
Suffix:
Gender:F
Credentials:DDS JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 AUDUBON RD
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2406
Mailing Address - Country:US
Mailing Address - Phone:610-666-7590
Mailing Address - Fax:
Practice Address - Street 1:2642 AUDUBON RD
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-2406
Practice Address - Country:US
Practice Address - Phone:610-666-7590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS17422L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice