Provider Demographics
NPI:1790708956
Name:HEATH, PAUL WARREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WARREN
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 1:609 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MC LOUTH
Mailing Address - State:KS
Mailing Address - Zip Code:66054-5205
Mailing Address - Country:US
Mailing Address - Phone:913-796-6113
Mailing Address - Fax:913-796-6098
Practice Address - Street 1:609 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MC LOUTH
Practice Address - State:KS
Practice Address - Zip Code:66054-5205
Practice Address - Country:US
Practice Address - Phone:913-796-6113
Practice Address - Fax:913-796-6098
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist