Provider Demographics
NPI:1770688863
Name:MONTGOMERY D. HEATHMAN, D.D.S., P.A.
Entity Type:Organization
Organization Name:MONTGOMERY D. HEATHMAN, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTGOMERY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEATHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-756-6155
Mailing Address - Street 1:1333 ARAPAHO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-6936
Mailing Address - Country:US
Mailing Address - Phone:479-756-6155
Mailing Address - Fax:479-725-1779
Practice Address - Street 1:1333 ARAPAHO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6936
Practice Address - Country:US
Practice Address - Phone:479-756-6155
Practice Address - Fax:479-725-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty