Provider Demographics
NPI:1033251855
Name:VU-HEATON, TINA T (DMD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:T
Last Name:VU-HEATON
Suffix:
Gender:F
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:PO BOX 9444
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29290-0444
Mailing Address - Country:US
Mailing Address - Phone:803-783-1198
Mailing Address - Fax:803-783-1892
Practice Address - Street 1:1211 GREENLAWN DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2631
Practice Address - Country:US
Practice Address - Phone:803-783-1198
Practice Address - Fax:803-783-1892
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3751122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist