Provider Demographics
NPI:1508248279
Name:ATHENA VU DDS PLLC.
Entity Type:Organization
Organization Name:ATHENA VU DDS PLLC.
Other - Org Name:PREMIER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
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 1:1122 NORTH 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001
Mailing Address - Country:US
Mailing Address - Phone:704-982-5516
Mailing Address - Fax:704-983-8985
Practice Address - Street 1:1122 NORTH 6TH STREET
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:704-982-5516
Practice Address - Fax:704-983-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918823Medicaid