Provider Demographics
NPI:1831112903
Name:HEARD, JANICE L (DDS, PA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:HEARD
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:L
Other - Last Name:HEARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-0009
Mailing Address - Country:US
Mailing Address - Phone:919-556-6761
Mailing Address - Fax:919-556-0066
Practice Address - Street 1:310 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571-9661
Practice Address - Country:US
Practice Address - Phone:919-556-6761
Practice Address - Fax:919-556-0066
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998285Medicaid
NC8998285Medicaid