Provider Demographics
NPI:1386808129
Name:DANIEL, HEIDI LEIGH (DMD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LEIGH
Last Name:DANIEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W MACON LN
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4776
Mailing Address - Country:US
Mailing Address - Phone:907-830-7202
Mailing Address - Fax:
Practice Address - Street 1:127 W MACON LN
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4776
Practice Address - Country:US
Practice Address - Phone:907-830-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AK1504122300000X
TN9535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program