Provider Demographics
NPI:1992835391
Name:DELUCA, VIVIAN C (DMD)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:C
Last Name:DELUCA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:VIVIAN
Other - Middle Name:C
Other - Last Name:TERHUNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4945 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-4813
Mailing Address - Country:US
Mailing Address - Phone:813-365-3552
Mailing Address - Fax:800-869-5053
Practice Address - Street 1:4945 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4813
Practice Address - Country:US
Practice Address - Phone:813-365-3552
Practice Address - Fax:800-869-5053
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN160851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice