Provider Demographics
NPI:1528492824
Name:HEATH, MARQUIS D (DDS)
Entity type:Individual
Prefix:DR
First Name:MARQUIS
Middle Name:D
Last Name:HEATH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1504
Mailing Address - Country:US
Mailing Address - Phone:214-257-1082
Mailing Address - Fax:
Practice Address - Street 1:3900 JUNIUS ST STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1602
Practice Address - Country:US
Practice Address - Phone:214-257-1082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1348931223G0001X
AL6046C11223G0001X
LA66331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1866334Medicaid
LA1866334Medicaid