Basic Information
| Provider Information | |||||||||
| NPI: | 1952615650 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEAPHY | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 323 W ALDER ST | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598024123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062584789 | ||||||||
| FaxNumber: | 4062584180 | ||||||||
| Practice Location | |||||||||
| Address1: | 323 W ALDER ST | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598024123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062584789 | ||||||||
| FaxNumber: | 4062584180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2010 | ||||||||
| LastUpdateDate: | 03/21/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2418 | MT | Y | Dental Providers | Dentist |
No ID Information.