Provider Demographics
NPI:1316516891
Name:HEAVNER, ERIN REBECCA
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:REBECCA
Last Name:HEAVNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3216
Mailing Address - Country:US
Mailing Address - Phone:704-813-1114
Mailing Address - Fax:
Practice Address - Street 1:904 DONTIA DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3643
Practice Address - Country:US
Practice Address - Phone:704-735-0765
Practice Address - Fax:704-735-4506
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice