Provider Demographics
NPI:1528536745
Name:OJEDA, VIVIANA ANGELINA
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:ANGELINA
Last Name:OJEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GOLD ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5922
Mailing Address - Country:US
Mailing Address - Phone:203-446-6627
Mailing Address - Fax:
Practice Address - Street 1:428 COLUMBUS AVENUE
Practice Address - Street 2:COLUMBUS DENTAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1233
Practice Address - Country:US
Practice Address - Phone:203-503-3040
Practice Address - Fax:203-503-3187
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT123081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235893Medicaid