Individual
DR. JODI HEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7006 S CENTRAL AVE, PHOENIX, AZ 85042-5423
(602) 276-1029
(602) 276-1838
Mailing address
7006 S CENTRAL AVE, PHOENIX, AZ 85042-5423
(602) 276-1029
(602) 276-1838
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5405
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
578106
AHCCCS
AZ
Enumeration date
04/11/2006
Last updated
12/11/2013
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