Provider Demographics
NPI:1699157057
Name:RENC, HEATHER LEONARD (DMD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LEONARD
Last Name:RENC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:RENEE
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:105 N LITCHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 N LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1617
Practice Address - Country:US
Practice Address - Phone:623-932-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0089831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice