Provider Demographics
NPI:1689709867
Name:DAVID W. HEATON, DDS, PA
Entity Type:Organization
Organization Name:DAVID W. HEATON, DDS, PA
Other - Org Name:ONECO DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-758-3999
Mailing Address - Street 1:1612 53RD AVE E
Mailing Address - Street 2:PO BOX 1394
Mailing Address - City:ONECO
Mailing Address - State:FL
Mailing Address - Zip Code:34264-1394
Mailing Address - Country:US
Mailing Address - Phone:941-758-3999
Mailing Address - Fax:
Practice Address - Street 1:1612 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203
Practice Address - Country:US
Practice Address - Phone:941-758-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10302122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty