Provider Demographics
NPI:1285193417
Name:ERIC A HEAP DDS PC
Entity Type:Organization
Organization Name:ERIC A HEAP DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BREYMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-831-1700
Mailing Address - Street 1:2125 E WARNER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3490
Mailing Address - Country:US
Mailing Address - Phone:480-831-1700
Mailing Address - Fax:480-831-2964
Practice Address - Street 1:2125 E WARNER RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3490
Practice Address - Country:US
Practice Address - Phone:480-831-1700
Practice Address - Fax:480-831-2964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies