Provider Demographics
NPI:1093451510
Name:SEPULVEDA, VIVIANA CAROLINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIVIANA
Middle Name:CAROLINA
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10075 S JOG RD STE 301
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3537
Mailing Address - Country:US
Mailing Address - Phone:561-208-8009
Mailing Address - Fax:
Practice Address - Street 1:10075 S JOG RD STE 301
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3537
Practice Address - Country:US
Practice Address - Phone:561-208-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-08
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice