Provider Demographics
NPI:1942590203
Name:HEATON, JOHN FREDRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDRICK
Last Name:HEATON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:556 CYNWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3886
Mailing Address - Country:US
Mailing Address - Phone:410-822-1442
Mailing Address - Fax:410-822-1443
Practice Address - Street 1:556 CYNWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3886
Practice Address - Country:US
Practice Address - Phone:410-822-1442
Practice Address - Fax:410-822-1443
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD71261223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics