Provider Demographics
NPI:1073647079
Name:MIELCAREK, VIVIAN UYEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:UYEN
Last Name:MIELCAREK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6533 PRESTON RD
Mailing Address - Street 2:200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2697
Mailing Address - Country:US
Mailing Address - Phone:972-608-1000
Mailing Address - Fax:
Practice Address - Street 1:6533 PRESTON RD
Practice Address - Street 2:200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2697
Practice Address - Country:US
Practice Address - Phone:972-608-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice