Provider Demographics
NPI:1538279278
Name:FRENCH, VIVIAN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:LEE
Last Name:FRENCH
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 1:52 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9220
Mailing Address - Country:US
Mailing Address - Phone:304-757-0970
Mailing Address - Fax:
Practice Address - Street 1:139 7TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1453
Practice Address - Country:US
Practice Address - Phone:304-744-4670
Practice Address - Fax:304-744-4697
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0137046000Medicaid
WV669952OtherUNITED CONCORDIA INSUR. N