MEDICARE: DR. JANICE L. HEARD DDS, P.A.

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	302F00000X	Exclusive Provider Organization	5531	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063426716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JANICE L. HEARD DDS, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 9
Second Line	:
City	:	ROLESVILLE
State	:	NC
Zip	:	27571-0009
Country	:	US
Telephone Number	:	919-556-6761
Fax Number	:	919-556-0066

Provider Business Practice Location Address
First Line	:	310 S MAIN ST
Second Line	:
City	:	ROLESVILLE
State	:	NC
Zip	:	27571-9661
Country	:	US
Telephone Number	:	919-556-6761
Fax Number	:	919-556-0066

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JANICE MILLER
Credential	:
Telephone Number	:	919-556-6761

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	09/04/2007

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