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General NPI Number Information
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NPI Number | 1689709867
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Entity Type | Organization
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Legal Business Name | DAVID W. HEATON, DDS, PA
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 1612 53RD AVE E
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City | BRADENTON
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State | FL
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Zip | 34203
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Country | US
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Telephone | 941-758-3999
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Fax |
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Provider Business Mailing Address
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Address Line | 1612 53RD AVE E PO BOX 1394
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City | ONECO
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State | FL
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Zip | 34264-1394
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Country | US
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Telephone | 941-758-3999
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID W HEATON
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Credential | D.D.S.
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Telephone | 941-758-3999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN10302
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License Number State | FL
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