Provider Demographics
NPI:1194312637
Name:THERESA HEATON DMD PLLC
Entity type:Organization
Organization Name:THERESA HEATON DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:903-650-8005
Mailing Address - Street 1:570 S US HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:TX
Mailing Address - Zip Code:75452-2731
Mailing Address - Country:US
Mailing Address - Phone:903-650-8005
Mailing Address - Fax:
Practice Address - Street 1:570 S US HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:TX
Practice Address - Zip Code:75452-2731
Practice Address - Country:US
Practice Address - Phone:903-650-8005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental