Individual
DIANE J HECKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
230 N MORTON ST, BLOOMINGTON, IN 47404-3964
(128) 333-3330
(128) 333-3067
Mailing address
230 N MORTON ST, BLOOMINGTON, IN 47404-3964
(128) 333-3330
(128) 333-3067
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009390C
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200223800
—
IN
Enumeration date
11/20/2006
Last updated
07/21/2020
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