Provider Demographics
NPI:1285130120
Name:HEATH, ANDREW DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DAVID
Last Name:HEATH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2614 CLUBLAKE TRL
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-4006
Mailing Address - Country:US
Mailing Address - Phone:501-730-1017
Mailing Address - Fax:
Practice Address - Street 1:2613 SENTINEL WAY STE 300
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-2798
Practice Address - Country:US
Practice Address - Phone:972-369-7234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-31
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX375771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program