Provider Demographics
NPI:1114619624
Name:ATHENA VU DDS PLLC 3
Entity Type:Organization
Organization Name:ATHENA VU DDS PLLC 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-500-1355
Mailing Address - Street 1:16308 AUTUMN COVE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-1327
Mailing Address - Country:US
Mailing Address - Phone:704-500-1355
Mailing Address - Fax:
Practice Address - Street 1:1520 SOUTH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4799
Practice Address - Country:US
Practice Address - Phone:704-389-5087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty