Provider Demographics
NPI:1568708402
Name:RAMIREZ, VIVIANA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIVIANA
Middle Name:M
Last Name:RAMIREZ
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 1:5601 WESLEY ST # A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6320
Mailing Address - Country:US
Mailing Address - Phone:903-686-1892
Mailing Address - Fax:
Practice Address - Street 1:5601 WESLEY ST # A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6320
Practice Address - Country:US
Practice Address - Phone:903-686-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29412122300000X
390200000X
NY057222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program