Active NPI
Travis Glenn Heaton, DDS
- General Practice Dentistry
- Tyler, TX
National Provider Identifier
1265783310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 28244
- Practice address
- 4700 Kinsey Dr
Tyler, TX 75703-1009 - Phone
- (903) 245-9413
- NPI assigned
- Sep 28, 2012
- Last updated
- Sep 28, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 28244 | TX | Primary |
Addresses
Primary practice location
4700 Kinsey Dr
Tyler, TX 75703-1009
Mailing address
4700 Kinsey Dr
Tyler, TX 75703-1009
Phone (903) 245-9413
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160321001801 | TX | Order and Referring Only - Dentist | 3577868447 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28244 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348790400000",
"number": "1265783310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4700 KINSEY DR",
"city": "TYLER",
"state": "TX",
"postal_code": "757031009",
"telephone_number": "903-245-9413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 KINSEY DR",
"city": "TYLER",
"state": "TX",
"postal_code": "757031009",
"telephone_number": "903-245-9413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEATON",
"first_name": "TRAVIS",
"middle_name": "GLENN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-28",
"last_updated": "2012-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "28244",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
- Heaton Ear Nose and Throat Associates of East Texas P a (ENT Associates of East Texas)
- Heaton Health Services Agency LLC
- Heaton Laser and Surgery Center L L C
- Charles Lawson Heaton, M. D.
- Steuart Lawrence Heaton, MD
- Renee Suzanne Hebbeler-Clark, M.D.
- Marvin Heck, MD
- David Alphonso Hector, MD
- Hedgecock Artificial Limb Co., Inc
- Sara Louise Hedges
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.