John Edward Heldridge, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DE00004286 Issued in WA

Practice address

21701 76TH Ave W
Suite 202
Edmonds, WA 98026-7536

Phone

(425) 744-1724

NPI assigned

May 22, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 24, 2017 through Oct 24, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093924243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21701 76TH AVE W",
            "address_2": "SUITE 202",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267536",
            "telephone_number": "425-744-1724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21701 76TH AVE W",
            "address_2": "SUITE 202",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267536",
            "telephone_number": "425-744-1724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HELDRIDGE",
        "first_name": "JOHN",
        "middle_name": "EDWARD",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE00004286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5350608",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Lawrence Headley, M.D.
• Health and Wellness Clinic PLLC
• Christina Healy
• William Healy, MA, CDP
• David L Heard, M.D.
• Kylee Hellstern
• Angela Hendrix, LMP
• J Linn Black Henline, LMP, SAMP
• Keun Her, L.M.P.
• Laura Hernandez

• Oral and Maxillofacial Surgery (Dentist) in Edmonds, WA
• Providers in Edmonds, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.