Provider Demographics
NPI:1679750756
Name:COLLEDGE, HEATH R (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEATH
Middle Name:R
Last Name:COLLEDGE
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 8
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84771-0008
Mailing Address - Country:US
Mailing Address - Phone:435-673-9606
Mailing Address - Fax:435-673-6812
Practice Address - Street 1:427 W 100 S
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3375
Practice Address - Country:US
Practice Address - Phone:435-673-9606
Practice Address - Fax:435-673-6812
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6620093-99221223G0001X
NV56101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice