Active NPI
Lisa Jan Haddox-Heston, D.D.S.
- Dentist
- Logan, WV
National Provider Identifier
1881858637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2962
- Practice address
- 1 Wildcat Way
Logan, WV 25601-3474 - Phone
- (304) 688-9949
- Fax
- (304) 688-9953
- NPI assigned
- Jul 10, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2962 | WV | Primary |
Addresses
Primary practice location
1 Wildcat Way
Logan, WV 25601-3474
Mailing address
7400 Lynn Ave
Hamlin, WV 25523-1138
Phone (304) 824-5806
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2962 | WV | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430179200000",
"number": "1881858637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7400 LYNN AVE",
"city": "HAMLIN",
"state": "WV",
"postal_code": "255231138",
"telephone_number": "304-824-5806",
"fax_number": "304-824-5804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 WILDCAT WAY",
"city": "LOGAN",
"state": "WV",
"postal_code": "256013474",
"telephone_number": "304-688-9949",
"fax_number": "304-688-9953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HADDOX-HESTON",
"first_name": "LISA",
"middle_name": "JAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-10",
"last_updated": "2015-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WV",
"license": "2962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Logan, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.