| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1612 53rd Ave E, Bradenton, Florida |
| Authorized Official Name and Position | David W Heaton (PRESIDENT) |
| Authorized Official Contact | 9417583999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1612 53rd Ave E Po Box 1394 Oneco FL 34264-1394 Ph: (941) 758-3999 | 1612 53rd Ave E Bradenton FL 34203 Ph: (941) 758-3999 |
| NPI Number | 1689709867 |
|---|---|
| Provider Enumeration Date | 02/21/2007 |
| Last Update Date | 06/12/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689709867 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN10302 (Florida) | Primary |
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