Provider Demographics
NPI:1366655805
Name:VALERIANO, VIVECA JOAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVECA
Middle Name:JOAN
Last Name:VALERIANO
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 1:4411 E. 5TH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2020
Mailing Address - Country:US
Mailing Address - Phone:520-795-7200
Mailing Address - Fax:520-327-9190
Practice Address - Street 1:4411 E. 5TH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2020
Practice Address - Country:US
Practice Address - Phone:520-795-7200
Practice Address - Fax:520-327-9190
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ47201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice