Individual
HEENAN JOHNSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2204 ITHACA AVE, LUBBOCK, TX 79410-3206
(806) 793-4438
Mailing address
2204 ITHACA AVE, SUITE B, LUBBOCK, TX 79410-1300
(806) 793-4438
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15727
TX
Other
Enumeration date
02/14/2006
Last updated
07/09/2007
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