Provider Demographics
NPI:1598197964
Name:VIVI SPA DENTAL P.A
Entity Type:Organization
Organization Name:VIVI SPA DENTAL P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:THUVAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-617-0675
Mailing Address - Street 1:10722 KETCHUM VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7185
Mailing Address - Country:US
Mailing Address - Phone:813-671-0675
Mailing Address - Fax:
Practice Address - Street 1:10722 KETCHUM VALLEY DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7185
Practice Address - Country:US
Practice Address - Phone:813-671-0675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18603261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental