Provider Demographics
NPI:1619241619
Name:VIVA DENTAL 2 PLLC
Entity Type:Organization
Organization Name:VIVA DENTAL 2 PLLC
Other - Org Name:VIVA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEP
Authorized Official - Middle Name:BICH
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-893-6109
Mailing Address - Street 1:1050 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 432B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-2444
Mailing Address - Country:US
Mailing Address - Phone:214-893-6109
Mailing Address - Fax:214-337-7803
Practice Address - Street 1:1050 N WESTMORELAND RD
Practice Address - Street 2:SUITE 432B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-2444
Practice Address - Country:US
Practice Address - Phone:214-893-6109
Practice Address - Fax:214-337-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty