Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 0401413770 | VA |
Y | 1223D0004X | Dentist Anesthesiologist | 0401413770 | VA |
NPI | 1033425335 |
---|---|
Provider Name | Dr. Heather Ballentine |
First Address | Charlottesville, VA 22911-4600 |
Second Address | Charlottesville, VA 22911-4600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2010 |
Last Update Date | 19/05/2013 |