Healthcare Provider Details

I. General information

NPI: 1376615369
Provider Name (Legal Business Name): WILLIAM HEAGY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 AIRPORT HEIGHTS DR #265
ANCHORAGE AK
99508-2943
US

IV. Provider business mailing address

1200 AIRPORT HEIGHTS DR #265
ANCHORAGE AK
99508-2943
US

V. Phone/Fax

Practice location:
  • Phone: 907-278-5678
  • Fax:
Mailing address:
  • Phone: 907-278-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberAA615
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: