Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 13690 | FL |
NPI | 1063542066 |
---|---|
Provider Name | Dr. David Roger Heald |
First Address | Lehigh Acres, FL 33971-1309 |
Second Address | Lehigh Acres, FL 33971-1309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/02/2017 |