Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D008303 | AZ |
NPI | 1003195413 |
---|---|
Provider Name | James W. Heaton |
First Address | Chandler, AZ 85226-6224 |
Second Address | Chandler, AZ 85226-6224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2011 |
Last Update Date | 25/06/2019 |