Provider Demographics
NPI:1972672095
Name:HEFFERNAN, JAMES GREGORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GREGORY
Last Name:HEFFERNAN
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:403 WILLIAMSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1091
Mailing Address - Country:US
Mailing Address - Phone:630-208-7668
Mailing Address - Fax:630-208-7677
Practice Address - Street 1:520 N 12TH STREET
Practice Address - Street 2:VCU SCHOOL OF DENTISTRY, DEPT OF ENDODONTICS
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0566
Practice Address - Country:US
Practice Address - Phone:804-828-1778
Practice Address - Fax:804-827-1373
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04110000541223E0200X
IL0210017031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics