Provider Demographics
NPI:1073789442
Name:HEACOX, GAIL ANN (RDH, BS)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:ANN
Last Name:HEACOX
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 N SAND BROOK ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-5092
Mailing Address - Country:US
Mailing Address - Phone:509-868-0926
Mailing Address - Fax:
Practice Address - Street 1:1616 N SAND BROOK ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-5092
Practice Address - Country:US
Practice Address - Phone:509-868-0926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00005545124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist