Provider Demographics
NPI:1841557105
Name:HEATON PEDIATRICS, PLLC
Entity type:Organization
Organization Name:HEATON PEDIATRICS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-698-0641
Mailing Address - Street 1:701 INDIAN TRL
Mailing Address - Street 2:SUITE C
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2153
Mailing Address - Country:US
Mailing Address - Phone:254-698-0641
Mailing Address - Fax:254-698-0644
Practice Address - Street 1:701 INDIAN TRL
Practice Address - Street 2:SUITE C
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2153
Practice Address - Country:US
Practice Address - Phone:254-698-0641
Practice Address - Fax:254-698-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty