Provider Demographics
NPI:1003195413
Name:HEATON, JAMES W (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:HEATON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 W RAY RD STE 8
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-6224
Mailing Address - Country:US
Mailing Address - Phone:614-905-6192
Mailing Address - Fax:
Practice Address - Street 1:4940 W RAY RD STE 8
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-6224
Practice Address - Country:US
Practice Address - Phone:614-905-6192
Practice Address - Fax:480-917-4780
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist