Provider Demographics
NPI:1952629834
Name:HEATHER L. ALTON DMD PA
Entity Type:Organization
Organization Name:HEATHER L. ALTON DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-448-0441
Mailing Address - Street 1:8841 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4244
Mailing Address - Country:US
Mailing Address - Phone:904-448-0441
Mailing Address - Fax:904-448-0456
Practice Address - Street 1:8841 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4244
Practice Address - Country:US
Practice Address - Phone:904-448-0441
Practice Address - Fax:904-448-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLDN130241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty