Provider Demographics
NPI:1114146123
Name:HEATHMAN, WARNER EVANS (DDS)
Entity type:Individual
Prefix:DR
First Name:WARNER
Middle Name:EVANS
Last Name:HEATHMAN
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 1:4010 VISTA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2183
Mailing Address - Country:US
Mailing Address - Phone:713-947-8832
Mailing Address - Fax:
Practice Address - Street 1:4010 VISTA RD
Practice Address - Street 2:SUITE B
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2183
Practice Address - Country:US
Practice Address - Phone:713-947-8832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery