Provider Demographics
NPI:1649067687
Name:HEBERTSON, DILLON (DDS)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:
Last Name:HEBERTSON
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 W 180TH ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-5933
Mailing Address - Country:US
Mailing Address - Phone:540-216-8969
Mailing Address - Fax:
Practice Address - Street 1:110 BERGEN ST RM B854
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-3126
Practice Address - Fax:973-972-7322
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program