Provider Demographics
NPI:1679663579
Name:TEEGARDIN, VIVIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:
Last Name:TEEGARDIN
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 1:1214 DIXIELAND RD
Mailing Address - Street 2:SIUITE #4
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3351
Mailing Address - Country:US
Mailing Address - Phone:956-428-5322
Mailing Address - Fax:956-428-7986
Practice Address - Street 1:1214 DIXIELAND RD
Practice Address - Street 2:SIUITE #4
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3351
Practice Address - Country:US
Practice Address - Phone:956-428-5322
Practice Address - Fax:956-428-7986
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82D007OtherBLUE CROSS BLUE SHIELD