Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0401413470 | VA |
NPI | 1043585995 |
---|---|
Provider Name | Heidi Ostreng Vatanka |
First Address | Alexandria, VA 22305-1828 |
Second Address | Fairfax, VA 22031-4621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2012 |
Last Update Date | 11/03/2012 |