Provider Demographics
NPI:1295055739
Name:HEFFELFINGER, MICHAEL G (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:HEFFELFINGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 CEDAR SPRINGS RD
Mailing Address - Street 2:#2507
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-1203
Mailing Address - Country:US
Mailing Address - Phone:610-509-8992
Mailing Address - Fax:
Practice Address - Street 1:1405 W MOORE AVE
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2303
Practice Address - Country:US
Practice Address - Phone:972-563-8383
Practice Address - Fax:972-563-8384
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212837303Medicaid