Provider Demographics
NPI:1588904171
Name:HEARON, HEATHER ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANN
Last Name:HEARON
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 1:752 LOWER MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1480
Mailing Address - Country:US
Mailing Address - Phone:808-244-4559
Mailing Address - Fax:808-244-9012
Practice Address - Street 1:752 LOWER MAIN ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1480
Practice Address - Country:US
Practice Address - Phone:808-244-4559
Practice Address - Fax:808-244-9012
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2498122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist