Provider Demographics
NPI:1770645004
Name:VIVIANO, JOSEPH PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PETER
Last Name:VIVIANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 W MARCH LANE
Mailing Address - Street 2:SUITE 2040
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219
Mailing Address - Country:US
Mailing Address - Phone:209-477-1227
Mailing Address - Fax:209-477-3190
Practice Address - Street 1:3133 W MARCH LANE
Practice Address - Street 2:SUITE 2040
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219
Practice Address - Country:US
Practice Address - Phone:209-477-1227
Practice Address - Fax:209-477-3190
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADM031877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist