Provider Demographics
NPI:1871509794
Name:HEYAMOTO, GARY ELDEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ELDEN
Last Name:HEYAMOTO
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 1:1729 208TH ST SE
Mailing Address - Street 2:#101
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7789
Mailing Address - Country:US
Mailing Address - Phone:425-485-8885
Mailing Address - Fax:425-485-8341
Practice Address - Street 1:1729 208TH ST SE
Practice Address - Street 2:#101
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-7789
Practice Address - Country:US
Practice Address - Phone:425-485-8885
Practice Address - Fax:425-485-8341
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA54331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice