Provider Demographics
NPI:1710423819
Name:DE LA CAMARA, VIVIANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIVIANNE
Middle Name:
Last Name:DE LA CAMARA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VIVIANNE
Other - Middle Name:
Other - Last Name:DE LA CAMARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:270 WESTWARD DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5260
Mailing Address - Country:US
Mailing Address - Phone:305-381-5669
Mailing Address - Fax:305-967-8897
Practice Address - Street 1:270 WESTWARD DR
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5260
Practice Address - Country:US
Practice Address - Phone:305-381-5669
Practice Address - Fax:305-967-8897
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist