Provider Demographics
NPI:1669832226
Name:HELLER, GRETCHEN (RDH)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:HELLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-8306
Mailing Address - Country:US
Mailing Address - Phone:856-863-0903
Mailing Address - Fax:
Practice Address - Street 1:53 S LAUREL ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1946
Practice Address - Country:US
Practice Address - Phone:856-451-4700
Practice Address - Fax:856-575-0818
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22HI00442500124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist