Provider Demographics
NPI:1689627309
Name:KHALIFE, VIVIANNE J (DDS)
Entity Type:Individual
Prefix:
First Name:VIVIANNE
Middle Name:J
Last Name:KHALIFE
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 1:2 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4600
Mailing Address - Country:US
Mailing Address - Phone:774-688-9226
Mailing Address - Fax:
Practice Address - Street 1:1136 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7111
Practice Address - Country:US
Practice Address - Phone:401-521-3661
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN028981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice