Provider Demographics
NPI:1790022432
Name:HEATH, WILLIAM H (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:HEATH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3759 CONSTELLATION RD
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-1401
Mailing Address - Country:US
Mailing Address - Phone:805-733-4574
Mailing Address - Fax:805-733-1665
Practice Address - Street 1:3759 CONSTELLATION RD
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-1401
Practice Address - Country:US
Practice Address - Phone:805-733-4574
Practice Address - Fax:805-733-1665
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice