Provider Demographics
NPI:1316089808
Name:RORISON, HEATHER DAWN (DMD PLLC)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:DAWN
Last Name:RORISON
Suffix:
Gender:F
Credentials:DMD PLLC
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:D
Other - Last Name:RORISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:3541 RANDOLPH RD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211
Mailing Address - Country:US
Mailing Address - Phone:704-366-6186
Mailing Address - Fax:704-366-3792
Practice Address - Street 1:3541 RANDOLPH RD.
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211
Practice Address - Country:US
Practice Address - Phone:704-366-6186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC78021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice