Individual
DR. LARRY HEATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
107 H. ST. EAST, POPLAR, MT 59255
(406) 768-2129
(406) 786-3423
Mailing address
107 H. ST. EAST, POPLAR, MT 59255
(406) 768-2129
(406) 768-3423
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
24113
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2210068
—
MT
01
—
24113
CALIFORNIA STATE BOARD
CA
Enumeration date
09/22/2006
Last updated
01/16/2013
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