Provider Demographics
NPI:1770106106
Name:HEIT, JENNIFER (CDA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HEIT
Suffix:
Gender:F
Credentials:CDA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MCLAURIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDA
Mailing Address - Street 1:1814 E CROCUS DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4517
Mailing Address - Country:US
Mailing Address - Phone:602-568-4395
Mailing Address - Fax:
Practice Address - Street 1:8535 E HARTFORD DR STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5443
Practice Address - Country:US
Practice Address - Phone:480-515-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
212481126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant