Provider Demographics
NPI:1467531418
Name:HEARN, FRED ANDERSON III (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:ANDERSON
Last Name:HEARN
Suffix:III
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 1:1924 JUAN TABO BLVD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3314
Mailing Address - Country:US
Mailing Address - Phone:505-299-1872
Mailing Address - Fax:505-296-7077
Practice Address - Street 1:1924 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3314
Practice Address - Country:US
Practice Address - Phone:505-299-1872
Practice Address - Fax:505-296-7077
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD9461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice