Organization
ELISSA HEARD DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELISSA HEARD DMD (DENTIST OWNER)
(617) 471-8640
Entity
Organization
Contact information
Practice address
111 WILLARD ST 1B, QUINCY, MA 02169
(617) 471-8640
(617) 471-9328
Mailing address
111 WILLARD ST 1B, QUINCY, MA 02169
(617) 471-8640
(617) 471-9328
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13671
MA
1223G0001X
General Practice Dentistry
16163
MA
1223G0001X
General Practice Dentistry
17259
MA
1223G0001X
General Practice Dentistry
21465
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1131
DELTA
—
01
—
4983
BCBS
—
Enumeration date
01/19/2007
Last updated
08/22/2020
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