Provider Demographics
NPI:1215027552
Name:HEAP, ALAN RAY (DMD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:RAY
Last Name:HEAP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 S HIAWASSEE RD
Mailing Address - Street 2:#216
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8746
Mailing Address - Country:US
Mailing Address - Phone:407-578-3734
Mailing Address - Fax:407-578-6394
Practice Address - Street 1:2295 S. HIAWASSEE RD
Practice Address - Street 2:#216
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835
Practice Address - Country:US
Practice Address - Phone:407-578-3734
Practice Address - Fax:407-578-6394
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist