Healthcare Provider Details

I. General information

NPI: 1265695431
Provider Name (Legal Business Name): GAVIN CHRISTOPHER HEYMANN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 OLD CHAPEL HILL RD
DURHAM NC
27707-3688
US

IV. Provider business mailing address

3206 OLD CHAPEL HILL RD
DURHAM NC
27707-3688
US

V. Phone/Fax

Practice location:
  • Phone: 919-967-0474
  • Fax:
Mailing address:
  • Phone: 919-967-0474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7988
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: