Provider Demographics
NPI:1063542066
Name:HEALD, DAVID ROGER (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROGER
Last Name:HEALD
Suffix:
Gender:M
Credentials:DMD
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Other - First Name:
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Mailing Address - Street 1:3400 LEE BLVD STE 110
Mailing Address - Street 2:SUITE G
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1309
Mailing Address - Country:US
Mailing Address - Phone:239-368-5679
Mailing Address - Fax:239-368-7802
Practice Address - Street 1:3400 LEE BLVD STE 110
Practice Address - Street 2:SUITE G
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1309
Practice Address - Country:US
Practice Address - Phone:239-368-5679
Practice Address - Fax:239-368-7802
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL136901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics