# DR. LARRY HEATER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1275633018
- **Gender:** Man
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 24113 | CA | Yes |

## Other

- **Enumeration date:** 09/22/2006
- **Last updated:** 01/16/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2210068 | — | MT |
| 01 | — | 24113 | CALIFORNIA STATE BOARD | CA |