Provider Demographics
NPI:1336436906
Name:HEATON, JUSTIN ANTHONY (DMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ANTHONY
Last Name:HEATON
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5417 NE 265TH ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-7713
Mailing Address - Country:US
Mailing Address - Phone:208-569-4169
Mailing Address - Fax:
Practice Address - Street 1:900 NE 139TH ST STE 106
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685
Practice Address - Country:US
Practice Address - Phone:360-604-9000
Practice Address - Fax:360-573-1417
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60739379122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00202327OtherCOLORADO DENTAL BOARD
UT8021817-9922OtherUTAH STATE DENTAL BOARD
NMDD4183OtherNEW MEXICO DENTAL BOARD
MO2015004889OtherMISSOURI DENTAL BOARD