Provider Demographics
NPI:1932293586
Name:HEFFNER AND AGUTO DENTISTRY
Entity Type:Organization
Organization Name:HEFFNER AND AGUTO DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HEFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:301-645-6556
Mailing Address - Street 1:3460 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602
Mailing Address - Country:US
Mailing Address - Phone:301-645-6556
Mailing Address - Fax:301-638-3131
Practice Address - Street 1:3460 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602
Practice Address - Country:US
Practice Address - Phone:301-645-6556
Practice Address - Fax:301-638-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD43241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty