Provider Demographics
NPI:1306468533
Name:PAUL, HEATHER (RDH & CBDH)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:RDH & CBDH
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:WAYNE, HEALTH GEOTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7842 LAND O LAKES BLVD #150
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638
Mailing Address - Country:US
Mailing Address - Phone:813-528-0433
Mailing Address - Fax:
Practice Address - Street 1:8839 HANDEL LOOP
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34637
Practice Address - Country:US
Practice Address - Phone:813-285-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH11389124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist