Provider Demographics
NPI:1376615369
Name:HEAGY, WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HEAGY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 AIRPORT HEIGHTS DR
Mailing Address - Street 2:#265
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2943
Mailing Address - Country:US
Mailing Address - Phone:907-278-5678
Mailing Address - Fax:
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR
Practice Address - Street 2:#265
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2943
Practice Address - Country:US
Practice Address - Phone:907-278-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA6151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK0000NGCFXMedicare ID - Type Unspecified