Provider Demographics
NPI:1043585995
Name:VATANKA, HEIDI OSTRENG (DDS)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:OSTRENG
Last Name:VATANKA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 MOSBY ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-1828
Mailing Address - Country:US
Mailing Address - Phone:571-527-0653
Mailing Address - Fax:
Practice Address - Street 1:8505 ARLINGTON BLVD
Practice Address - Street 2:STE 370
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4621
Practice Address - Country:US
Practice Address - Phone:703-849-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-11
Last Update Date:2012-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014134701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry