Provider Demographics
NPI:1932114766
Name:VIEN, LAURENT (DDS)
Entity Type:Individual
Prefix:
First Name:LAURENT
Middle Name:
Last Name:VIEN
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 1:7743 WEST LN STE C5
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7743 WEST LN STE C5
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3381
Practice Address - Country:US
Practice Address - Phone:209-474-1101
Practice Address - Fax:209-474-9734
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice