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General NPI Number Information
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NPI Number | 1639484983
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Entity Type | Organization
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Legal Business Name | W. TYLER HEATH, D.M.D., FAMILY DENTISTRY A DENT
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 1107 LOUISA STREET
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City | RAYVILLE
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State | LA
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Zip | 71269
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Country | US
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Telephone | 318-728-9585
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Fax | 318-728-9595
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Provider Business Mailing Address
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Address Line | 1107 LOUISA STREET
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City | RAYVILLE
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State | LA
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Zip | 71269
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Country | US
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Telephone | 318-728-9585
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Fax | 318-728-9595
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | WILLIAM TYLER HEATH
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Credential | D.M.D.
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Telephone | 318-728-9585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5110
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License Number State | LA
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