Provider Demographics
NPI:1306017876
Name:DR. JOSEPH P. VIVIANO DDS INC.
Entity Type:Organization
Organization Name:DR. JOSEPH P. VIVIANO DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:VIVIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-477-1227
Mailing Address - Street 1:3133 W MARCH LN STE 2040
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2361
Mailing Address - Country:US
Mailing Address - Phone:209-477-1227
Mailing Address - Fax:209-477-3190
Practice Address - Street 1:3133 W MARCH LN STE 2040
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2361
Practice Address - Country:US
Practice Address - Phone:209-477-1227
Practice Address - Fax:209-477-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA031877261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental