Provider Demographics
NPI:1073239547
Name:HEATON, JESSICA RENAE (RDH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENAE
Last Name:HEATON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6283 GRAY ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-5153
Mailing Address - Country:US
Mailing Address - Phone:970-739-3554
Mailing Address - Fax:
Practice Address - Street 1:7190 COLORADO BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-1808
Practice Address - Country:US
Practice Address - Phone:303-733-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002025950124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist