Provider Demographics
NPI:1578665469
Name:HEACOX, RICHARD DAVID (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:HEACOX
Suffix:
Gender:M
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:PO BOX 368
Mailing Address - Street 2:6200 KELLERS CHURCH RD
Mailing Address - City:PLUMSTEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18949-0368
Mailing Address - Country:US
Mailing Address - Phone:215-766-7670
Mailing Address - Fax:215-766-7726
Practice Address - Street 1:6200 KELLERS CHURCH RD
Practice Address - Street 2:
Practice Address - City:PLUMSTEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:18949-0368
Practice Address - Country:US
Practice Address - Phone:215-766-7670
Practice Address - Fax:215-766-7726
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027655L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist