Provider Demographics
NPI:1073747333
Name:MANJARRES, VIVIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:
Last Name:MANJARRES
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 1:2882 SW 175TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5553
Mailing Address - Country:US
Mailing Address - Phone:954-437-4720
Mailing Address - Fax:
Practice Address - Street 1:7735 NW 146TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1581
Practice Address - Country:US
Practice Address - Phone:305-556-7010
Practice Address - Fax:305-231-3984
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN186061223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics