Provider Demographics
NPI:1518252527
Name:VU, ATHENA (DDS)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:VU
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 1:16308 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 1:400 S TRYON ST STE M4
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28285-1902
Practice Address - Country:US
Practice Address - Phone:704-375-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91731223G0001X
LAS-549122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice