MEDICARE: HEATON PEDIATRICS, PLLC

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	1223P0221X	Pediatric Dentistry	27068	TX

General Provider Information

NPI Number	:	1841557105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEATON PEDIATRICS, PLLC

Provider Business Mailing Address
First Line	:	701 INDIAN TRL
Second Line	:	SUITE C
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2153
Country	:	US
Telephone Number	:	254-698-0641
Fax Number	:	254-698-0644

Provider Business Practice Location Address
First Line	:	701 INDIAN TRL
Second Line	:	SUITE C
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2153
Country	:	US
Telephone Number	:	254-698-0641
Fax Number	:	254-698-0644

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANDREW M HEATON
Credential	:	DDS
Telephone Number	:	254-698-0641

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	02/19/2013

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