Organization
SKIP TYSON DDS & STEPHANIE HEANEY DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE HEANEY DDS (OWNER)
(910) 791-7380
Entity
Organization
Contact information
Practice address
2606 IRON GATE DR, SUITE 200, WILMINGTON, NC 28412-2573
(910) 791-7380
Mailing address
2606 IRON GATE DR, SUITE 200, WILMINGTON, NC 28412-2573
(910) 791-7380
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
6504
NC
1223P0221X
Pediatric Dentistry
7278
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89903C
—
NC
01
—
9003C
BCBS
NC
Enumeration date
03/27/2008
Last updated
03/27/2008
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