MEDICARE: DR. ERIN B HEATHCOCK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5895	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194933820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN B HEATHCOCK D.D.S.

Provider Business Mailing Address
First Line	:	5222 N PORTLAND AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2070
Country	:	US
Telephone Number	:	405-947-1525
Fax Number	:

Provider Business Practice Location Address
First Line	:	5222 N PORTLAND AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2070
Country	:	US
Telephone Number	:	405-947-1525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/09/2008

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