Provider Demographics
NPI:1235254269
Name:REJEBIAN, VIVAN ANGELE (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVAN
Middle Name:ANGELE
Last Name:REJEBIAN
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 1:333 HOOPER ROAD
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760
Mailing Address - Country:US
Mailing Address - Phone:607-754-1832
Mailing Address - Fax:607-484-3609
Practice Address - Street 1:333 HOOPER ROAD
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760
Practice Address - Country:US
Practice Address - Phone:607-754-1832
Practice Address - Fax:607-484-3609
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY417241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics