Provider Demographics
NPI:1487231130
Name:VIVIAN, JORDYN (DMD)
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:VIVIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JORDYN
Other - Middle Name:
Other - Last Name:MARKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:11 ROBIN WAY
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-4910
Mailing Address - Country:US
Mailing Address - Phone:908-581-8097
Mailing Address - Fax:
Practice Address - Street 1:1908 LANDSTOWN CENTRE WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-1634
Practice Address - Country:US
Practice Address - Phone:757-431-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist