Provider Demographics
NPI:1376873414
Name:ACEVEDO, VIVIANA (DMD)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:
Last Name:ACEVEDO
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:CALLE 4 EE15 URB SANTA ANA
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-370-3349
Mailing Address - Fax:
Practice Address - Street 1:CALLE MARGINAL A2
Practice Address - Street 2:URB. MONTEVERDE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4026
Practice Address - Country:US
Practice Address - Phone:787-370-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist