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Individual
DR. PETER J. HEATH
Active
Individual
DR. PETER J. HEATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2503
NH
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
9545
MD
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
12434R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01063978A
IN MEDICAL LICENSE
IN
01
—
12011044A
IN DENTAL LICENSE
IN
01
—
12434R
MEDICAL LICENSE
LA
05
—
200870900
—
IN
01
—
2503
DENTAL LICENSE (INACTIVE)
NH
01
—
9545
DENTAL LICENSE
MD
Enumeration date
08/31/2005
Last updated
09/29/2015
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