Provider Demographics
NPI:1740029982
Name:HEO, GUN (DMD)
Entity type:Individual
Prefix:DR
First Name:GUN
Middle Name:
Last Name:HEO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GRAND OAK WAY
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-2664
Mailing Address - Country:US
Mailing Address - Phone:706-589-4873
Mailing Address - Fax:
Practice Address - Street 1:1805 EPPS BRIDGE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6127
Practice Address - Country:US
Practice Address - Phone:706-549-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist