Heather Victorine

Primary specialty

DentistTaxonomy code 122300000X

License

DN013227 Issued in GA

Practice address

175 Country Club Dr BLDG 300B
Stockbridge, GA 30281-7388

Phone

(678) 565-9452

Fax

(678) 565-9484

NPI assigned

Jan 4, 2007

Last updated

Oct 10, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stockbridge Dental Smiles 2 LLC

  dba Cumming Dental Smiles

  • General Practice Dentistry
  • Stockbridge, GA
  • NPI 1295614121
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1912054917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "259 ARROWHEAD BLVD",
            "address_2": "SUITE B-2",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302361167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 COUNTRY CLUB DR BLDG 300B",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817388",
            "telephone_number": "678-565-9452",
            "fax_number": "678-565-9484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICTORINE",
        "first_name": "HEATHER",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN013227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "175566289A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Venture Healthcare (Venture Physical Therapy Stockbridge)
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• Vibert Psychiatric Solutions, LLC
• Iesha Dominique Vibert, PMHNP-BC
• Daniel Roberts Vieira
• Village Podiatry Group LLC (Village Podiatry Centers)
• Vinel Health Case Management
• Jadaya Vines
• Vitalroute Medical Transport

• Dentist in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.