Provider Demographics
NPI:1881626166
Name:HEATH, CHAD DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:DAVID
Last Name:HEATH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 BURKARTH RD STE A
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-1487
Mailing Address - Country:US
Mailing Address - Phone:660-747-6206
Mailing Address - Fax:660-747-2615
Practice Address - Street 1:1301 SHAMROCK CT
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-2490
Practice Address - Country:US
Practice Address - Phone:660-747-6206
Practice Address - Fax:660-747-2615
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020165491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO01615478OtherUNITED HEALTH CARE