Provider Demographics
NPI:1376760454
Name:HEENAN, RAE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAE ANN
Middle Name:
Last Name:HEENAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 BUCKLINE XING
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5650
Mailing Address - Country:US
Mailing Address - Phone:770-730-0990
Mailing Address - Fax:770-934-1240
Practice Address - Street 1:2300 HENDERSON MILL RD NE
Practice Address - Street 2:SUITE 401
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2745
Practice Address - Country:US
Practice Address - Phone:770-938-3277
Practice Address - Fax:770-934-1240
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA115831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice