Provider Demographics
NPI:1881815678
Name:DUSTIN, VIVY LAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVY
Middle Name:LAM
Last Name:DUSTIN
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 1:68 DEARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5350
Mailing Address - Country:US
Mailing Address - Phone:203-869-6306
Mailing Address - Fax:
Practice Address - Street 1:68 DEARFIELD DR
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5350
Practice Address - Country:US
Practice Address - Phone:203-869-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT76821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice