Provider Demographics
NPI:1669544334
Name:HEANEY D.D.S. P.C., STEPHEN MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MATTHEW
Last Name:HEANEY D.D.S. P.C.
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:64 ORLAND SQUARE DR
Mailing Address - Street 2:SUITE 216
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6542
Mailing Address - Country:US
Mailing Address - Phone:708-403-3393
Mailing Address - Fax:708-403-3491
Practice Address - Street 1:64 ORLAND SQUARE DR
Practice Address - Street 2:SUITE 216
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6542
Practice Address - Country:US
Practice Address - Phone:708-403-3393
Practice Address - Fax:708-403-3491
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry