Provider Demographics
NPI:1508957309
Name:MAGHIRAN, VIVIEN MATIBAG (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIEN
Middle Name:MATIBAG
Last Name:MAGHIRAN
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 1:14755 FOOTHILL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-8050
Mailing Address - Country:US
Mailing Address - Phone:909-349-1360
Mailing Address - Fax:909-349-1290
Practice Address - Street 1:14755 FOOTHILL BLVD STE E
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-8050
Practice Address - Country:US
Practice Address - Phone:909-349-1360
Practice Address - Fax:909-349-1290
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice