Provider Demographics
NPI:1851487169
Name:HEARD, RANDY JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:JOSEPH
Last Name:HEARD
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 1:226 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-2528
Mailing Address - Country:US
Mailing Address - Phone:610-588-5151
Mailing Address - Fax:610-588-6135
Practice Address - Street 1:226 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-2528
Practice Address - Country:US
Practice Address - Phone:610-588-5151
Practice Address - Fax:610-588-6135
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO20693L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice