Provider Demographics
NPI:1154629293
Name:YATES, HEATHER MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARIE
Last Name:YATES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:HOLDREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 E BAY DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2532
Mailing Address - Country:US
Mailing Address - Phone:727-581-9515
Mailing Address - Fax:727-599-0714
Practice Address - Street 1:800 E BAY DR
Practice Address - Street 2:SUITE L
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2532
Practice Address - Country:US
Practice Address - Phone:727-581-9515
Practice Address - Fax:727-599-0714
Is Sole Proprietor?:No
Enumeration Date:2011-03-13
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN191201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice