Healthcare Provider Details

I. General information

NPI: 1467516997
Provider Name (Legal Business Name): STEPHANIE LEIGH HEANEY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2606 IRON GATE DR SUITE 200
WILMINGTON NC
28412-2573
US

IV. Provider business mailing address

2606 IRON GATE DR STE 200
WILMINGTON NC
28412-2494
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-7380
  • Fax: 910-791-8160
Mailing address:
  • Phone: 910-791-7380
  • Fax: 910-791-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7278
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7278
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: