Provider Demographics
NPI:1558511923
Name:NEIL, HILLYARD & HEATON, PLLC
Entity Type:Organization
Organization Name:NEIL, HILLYARD & HEATON, PLLC
Other - Org Name:ADVENTURE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-604-9000
Mailing Address - Street 1:900 NE 139TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685
Mailing Address - Country:US
Mailing Address - Phone:360-604-9000
Mailing Address - Fax:360-573-1417
Practice Address - Street 1:900 NE 139TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685
Practice Address - Country:US
Practice Address - Phone:360-604-9000
Practice Address - Fax:360-573-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
WADE000109591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1092108Medicaid