Provider Demographics
NPI:1861613309
Name:HEARN, JOEL P (DMD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:P
Last Name:HEARN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5555
Mailing Address - Country:US
Mailing Address - Phone:256-767-4150
Mailing Address - Fax:256-767-4131
Practice Address - Street 1:309 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5555
Practice Address - Country:US
Practice Address - Phone:256-767-4150
Practice Address - Fax:256-767-4131
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL93225OtherPROVIDER NUMBER