Provider Demographics
NPI:1891892444
Name:HELLER, DIANE BAVER (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:BAVER
Last Name:HELLER
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 1:750 KAPPOCK ST
Mailing Address - Street 2:APT 711
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4612
Mailing Address - Country:US
Mailing Address - Phone:718-796-6728
Mailing Address - Fax:
Practice Address - Street 1:101 S BEDFORD RD
Practice Address - Street 2:SUITE 410
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3439
Practice Address - Country:US
Practice Address - Phone:914-241-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041847-11223E0200X
CT0081441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics